Predicting Outcome in Metformin Lactic Acidosis by Diane Calello A 56-year-old male with diabetes and hepatitis comes in after an intentional overdose of his own metformin. On evaluation, he is awake and alert but mildly tachycardic. Lab evaluation demonstrates elevated lactate at 4 mmol/L and a pH of 7.3. Will he die? Metformin is one […]
by Meghan Spyres You take the perilous sign out of a 55-year-old patient with alcohol use disorder (AUD) who came to the ED intoxicated. “He’s just metabolizing” your colleague tells you. A few hours go by and he is now awake and asking to leave. The nurse road tests him and he can walk, but […]
Since the publication of the sepsis trilogy, PROMISE, ARISE, and PROCESS 1,2,3, abruptly displaced early goal directed therapy (EGDT) as the cornerstone of sepsis management, we have been searching to fill the therapeutic vacuum its sudden departure left behind. The Center for Medicare and Medicaid Services (CMS) and the Surviving Sepsis Campaign (SSC) have both rushed […]
Lactate the Myths. Lactate is good for the patient and not bad.
Introduction with a case 0 Once upon a time a 60-year-old man was transferred from the oncology ward to the ICU for treatment of neutropenic septic shock. Over the course of the morning he started rigoring and dropped his blood pressure from 140/70 to 70/40 within a few hours, refractory to four liters of crystalloid. […]