Circulation

For hypotension due to metformin poisoning, first-line treatment is intravenous fluid resuscitation. If hypotension persists, start inotropic support with noradrenaline (norepinephrine) for its vasopressor effect (see Noradrenaline (norepinephrine) intravenous infusion instructions for advice on preparation and administration) and seek advice from a clinical toxicologist.