MALA and HD

 Q: The goal of hemodialysis in metformin overdose is to remove the drug from the body? 

 A) True 

B) False 

 Answer: B

The goal of hemodialysis (HD) in metformin overdose is to correct Metformin-Associated-Lactic-Acidosis (MALA). HD in MALA should be performed with a bicarbonate buffer with a target of lactic acid below 3 mmol/L and/or the pH above 7.35. 

To bridge the gap between MALA and logistic arrangements of HD, sodium bicarbonate infusion can be used to keep pH above 7.1, or 7.2 if signs of end-organ damage are present.

#toxicology

#nephrology

#acid-base

References:

1. Calello DP, Liu KD, Wiegand TJ, et al. Extracorporeal Treatment for Metformin Poisoning: Systematic Review and Recommendations From the Extracorporeal Treatments in Poisoning Workgroup. Crit Care Med 2015; 43:1716. 

2. Lalau JD, Lacroix C, Compagnon P, et al. Role of metformin accumulation in metformin-associated lactic acidosis. Diabetes Care 1995; 18:779.