Use of metformin in diabetic patients with CRF

First name:

Last name:

The most likely clinical diagnosis of the patient’s symptoms is:

	A Severe sepsis
	B Metformin-associated lactic acidosis (MALA)
	C Aspirin intoxication
	D Ketoacidosis
	E Ethylene glycol intoxication

To confirm the MALA diagnosis , the metformin blood level was measured and found
at 7mg/L (N<5mg/L). Which of the following conditions are necessary to explain
this elevation and its relationship with the appearance of MALA in this
patient?

	A Hepatic failure
	B Renal failure
	C Deshydration
	D High metformin dosage
	E b+c+d
	F c+d

In your opinion, what is the optimal management of MALA?

	A: Hemodialysis
	B: Metformin dose adjustment
	C: Definitive contra-indication of metformin
	D: All answers
	E: A+B