QuestionSBA
QuestionChoice
This patient has a mild lactic (metabolic) acidosis. This is likely due to organ hypoperfusion caused by heart failure. Metformin has been linked to the development/exacerbation of lactic acidosis, and therefore is the most important medication to hold.
10034872
a
Metformin
QuestionChoice
There is no indication to hold atorvastatin in this case, such as rhabdomyolysis or statin-induced myopathy. Metformin has been linked to the development/exacerbation of lactic acidosis, and therefore is the most important medication to hold.
10034874
c
Atorvastatin
QuestionChoice
Furosemide will be required to treat this patient's pulmonary oedema and heart failure. Metformin has been linked to the development/exacerbation of lactic acidosis, and therefore is the most important medication to hold.
10034873
b
Furosemide
QuestionChoice
Ramipril increases life expectancy in patients with heart failure. There is no current indication to hold it, e.g. an acute kidney injury or hypotension. Metformin has been linked to the development/exacerbation of lactic acidosis, and therefore is the most important medication to hold.
10034876
e
Ramipril
QuestionChoice
The patient's blood sugar is within range, and there is no reason at present to hold gliclazide. It may be held or reduced if the patient is commenced on a variable rate insulin infusion, however. Metformin has been linked to the development/exacerbation of lactic acidosis, and therefore is the most important medication to hold.
10034875
d
Gliclazide
Concept
Chapter
2693
6098
Lactic acidosis
Topic
202
Anesthetics and Intensive Care Medicine
19378
Metformin-associated lactic acidosis is a rare but serious complication, typically occurring in patients with renal impairment or conditions causing hypoxia. It results from lactate accumulation due to impaired gluconeogenesis and metabolism
A patient is admitted to hospital with a severe exacerbation of heart failure. They have a background of type 2 diabetes, hypertension, and hypercholesterolaemia.


An infusion of furosemide (10mg/hour) is commenced due to significant pulmonary oedema. A venous blood gas (VBG) shows:


||||
|--------------|:-------:|------------------|
|pH|7.32|7.35 - 7.45|
|PaO₂|4.9 kPa|11 - 15|
|PaCO₂|3.2 kPa|4.6 - 6.4|
|Bicarbonate|20.8 mmol/L|22 - 30|
|Lactate|3.4 mmol/L|0.6 - 1.4|
|Sodium|136 mmol/L|135 - 145|
|Potassium|4.3 mmol/L|3.5 - 5.3|
|Non-fasting Glucose|6.9 mmol/L|< 6.1|


Which medication is most important to stop in light of these results?
a