QuestionSBA
QuestionChoice
Clinical picture described above is that of a high anion gap metabolic acidosis with raised lactate level. Lactic acidosis is a rare or very rare, but potentially fatal side effect of metformin. Chronic stable heart failure is a risk factor for lactic acidosis. BNF advises that metformin should be witheld if dehydration occurs because acute kidney injury can precipiate lactic acidosis
34310
a
Metformin hydrochloride 500 mg PO three times daily
QuestionChoice
Carvedilol is not known to cause lactic acidosis
34311
b
Carvedilol 3.125 mg PO twice daily
QuestionChoice
Simvastatin is not known to cause metabolic acidosis
34314
e
Simvastatin 40 mg PO nightly
QuestionChoice
Lisinopril is not known to cause metabolic acidosis
34312
c
Lisinopril 10 mg PO once daily
QuestionChoice
Sertraline not known to cause metabolic acidosis
34313
d
Sertraline 50 mg PO once daily
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2805
Metformin side effects
Topic
74
Elderly Care
6873
Case presentation: A 65-year old man on the geriatric ward complains of nausea, vomiting and generalised muscle weakness. He was admitted to the hospital following a fall at home two days ago.  


PMH: Type 2 Diabetes Mellitus, Hypertension, Heart failure, Depression
DH: His current regular prescriptions are listed below
Examination: Dry lips and reduced skin turgor. Deep and laboured breathing. No added lung sounds. HS I+II+0. Abdomen soft non tender.
Investigation:

||||
|--------------|:-------:|------------------|
|pH|7.25|7.35 - 7.45|
|PaO₂|11 kPa|11 - 15|
|PaCO₂|3.8 kPa|4.6 - 6.4|
|Bicarbonate|12.1 mmol/L|22 - 30|
|Base Excess|-13.5 mmol/L|-2 to +2|
|Creatinine|300 µmol/L|60 - 120|
|Lactate|5.1 mmol/L|0.6 - 1.4|

Anion gap: 29 mmol/L
Negative urine toxicology


Question: Select the prescription that is most likely to be contributing to the clinical picture described above?
a