Treatment for metabolic acidosis: haemodialysis

Haemodialysis is recommended for patients with metformin poisoning if they have:

• severe metabolic acidosis—serum pH less than 7.0 or blood lactate concentration more than 20 mmol/L
• refractory hypotension that does not respond to intravenous fluid resuscitation and inotropic support
• rapid deterioration and acute kidney injury.

Seek advice from a clinical toxicologist. Haemodialysis does remove some metformin, but the main reason for its use is to correct metabolic acidosis.

Intermittent haemodialysis with a lactate-free dialysate is preferred, if available.

For more information on haemodialysis, see here.