IBCC Episode 32 - Metformin Toxicity

In this episode of The Internet Book of Critical Care Podcast, Josh and Adam discuss metformin toxicity, breaking it down into three categories: metformin-induced lactic acidosis (MILA), metformin-associated lactic acidosis (MALA), and metformin-unrelated lactic acidosis (MULA). They explore the cellular mechanisms, clinical presentations, and differential diagnoses of each category, emphasizing the importance of excluding other potential causes of lactic acidosis. The hosts delve into management strategies, including glucose control, volume resuscitation, and the controversial use of isotonic bicarbonate. They also discuss when to consider dialysis, vasopressors like Methylene Blue, and experimental therapies like GIK, while acknowledging the limited evidence supporting some interventions. The podcast stresses the importance of considering metformin toxicity in patients with lactic acidosis but cautions against overlooking other underlying conditions.