3. Metformin-associated lactic acidosis
The most likely cause of the acidosis in this situation is metformin-induced lactic acidosis (1). The patient was intubated for respiratory failure secondary to severe non-compensated metabolic acidosis and shortly thereafter was started on maximal pressor support with norepinephrine, vasopressin, epinephrine and phenylephrine. Continuous renal-replacement therapy and a sodium acetate drip (chosen due to a hospital and nation-wide bicarbonate shortage) were initiated for the acidosis.
How does sodium acetate improve metabolic acidosis? (Click on the correct answer to proceed to the third of four pages)