Guideline sources The following summarized guidelines for the management of metformin toxicity are prepared by our editorial team based on guidelines from the Extracorporeal Treatments in Poisoning Workgroup (EXTRIP 2015). 1 Guidelines 1. Therapeutic procedures Extracorporeal treatment (indications for initiation): recognize that metformin is moderately dialyzable. B Show 3 more Extracorporeal treatment (choice of technique): perform intermittent hemodialysis with bicarbonate buffer as the preferred modality for initial ECTR session in patients with metformin poisoning. B Show 2 more Extracorporeal treatment (indications for discontinuation): discontinue ECTR if lactate concentration is < 3 mmol/L and pH > 7.35. B Clinical findings Symptoms Past medical history https://web.pathway.md/diseases/recTy90poxxLTd13X 1/2 6/30/23, 1:02 AM Metformin toxicity Pathway Abdominal pain AKI Diarrhea Metformin Dyspepsia Neurological exam Fatigue Flatulence Altered mental status Loss of appetite Hematological findings Myalgia Nausea Megaloblastic anemia Vomiting Vital signs Hypotension body temperature Lab findings Lactic acidosis ECG findings Ventricular arrhythmia References 1. Diane P Calello, Kathleen D Liu, Timothy J Wiegand et al. Extracorporeal Treatment for Metformin Poisoning: Systematic Review and Recommendations From the Extracorporeal Treatments in Poisoning Workgroup. Crit Care Med. 2015 Aug;43 8 1716 30. Open https://web.pathway.md/diseases/recTy90poxxLTd13X 2/2