2001 results
Metformin Associated Lactic Acidosis (MALA) 

Pathophysiology of MALA
 - Metformin interferes with the activity of the
Metformin Associated ... Pathophysiology of MALA - Metformin ... recycles peripheral lactate ... production  increased lactate ... Kat_Watson #MALA #Metformin
Lactic Acidosis Classification - Type A vs Type B
Type A Lactic Acidosis: Sepsis, Ischemic bowel, Hemorrhagic
Short bowel (D-lactate ... Renal failure, Metformin
Diabetes Combination Tablets - Estimated A1c Lowering 
Metformin + DPP4 
• Janumet (metformin + sitagliptin) 
•
A1c Lowering Metformin ... DPP4 • Janumet (metformin ... • Jentadueto (metformin ... • Kombiglyze (metformin ... saxagliptin) Metformin
Metformin in Diabetic Kidney Disease
Immediate release:
 • Initial 500 mg or 850 mg once daily
 •
Metformin in Diabetic ... eGFR < 30: Stop metformin ... do not initiate metformin ... annually if on metformin ... #pharmacology #algorithm
Diabetes Type 2 Medication Management and Titration Algorithm
- First line therapy is metformin and comprehensive lifestyle
and Titration Algorithm ... line therapy is metformin ... Medication #Management #Algorithm
Crystalloid Composition - Normal Saline, Ringer's Lactate, Hartmann's Solution, PlasmaLyte

Ca2+ Mg2+ Cl- 
Acetate 
Lactate 
Gluconate 
Bicarbonate
Saline, Ringer's Lactate ... Ca2+ Mg2+ Cl- Acetate ... Lactate Gluconate ... #LR #Ringers #Lactated
Causes of Lactate Elevation, Lactic Acidosis - Differential Diagnosis

The most common causes of hyperlactatemia are usually:
Causes of Lactate ... categories Lactate ... The use of lactate ... With ↑ Lactate ... and Toxins: - Metformin
Metformin 
Current Renal Dose Adjustments due to Risk of Lactic Acidosis 
> 60 No adjustment 
45-60
Metformin Current ... already taking metformin ... /ambcarerx #Metformin
Algorithm for Metformin Prescribing and Dosing in CKD
Dose Initiation - Immediate release:
 • Initial 500 mg
Algorithm for Metformin ... maximum dose #Metformin ... #pharmacology #algorithm
Lactic Acidosis - Classification and Differential Diagnosis
Type A Lactic Acidosis: Inadequate Oxygen Delivery
 • Anaerobic muscular
Fructose, Isoniazid, Lactate-based ... dialysate, Metformin ... #TypeA #TypeB #lactate