A 68-year-old man with type 2 diabetes and stage 3 chronic kidney disease on metformin presents with malaise, abdominal discomfort, and tachypnea 6 hours after receiving intravenous contrast for CT imaging. Vital signs show BP 128/76 mmHg, HR 102/min, RR 24/min, temperature 37.2°C, SpO2 98% on room air. Laboratory studies reveal pH 7.28, bicarbonate 16 mEq/L, lactate 5.2 mmol/L, and elevated anion gap metabolic acidosis. Urinalysis shows no ketones. Which of the following is the most likely explanation?
- A)Metformin associated lactic acidosisGABARITO
- B)Methimazole toxicity
- C)Adrenal insufficiency
- D)Diabetic ketoacidosis
- E)Thyroid storm
Explicação
Metformin can rarely cause lactic acidosis, especially in patients with renal dysfunction or acute kidney injury after contrast exposure. Ver explicação completa e trilha adaptativa →