A 50-year-old woman on ICU has persistent lactic acidosis (lactate 6.5 mmol/L) despite apparent haemodynamic stability (MAP 72, CI 3.2, ScvO2 72%). Sh...

Question

A 50-year-old woman on ICU has persistent lactic acidosis (lactate 6.5 mmol/L) despite apparent haemodynamic stability (MAP 72, CI 3.2, ScvO2 72%). She is on metformin for type 2 diabetes and was admitted with AKI (creatinine 450 µmol/L). What is the most likely cause of the persistent lactic acidosis?

Accepted Answer

Metformin-associated lactic acidosis (MALA) due to renal accumulation

Answer

Ongoing occult tissue hypoperfusion

Answer

Hepatic failure with impaired lactate clearance

Answer

Thiamine deficiency

Answer

D-lactic acidosis from short bowel syndrome

uk-fficm MCQ (SBA): Metformin-Associated Lactic Acidosis