Ms. Gibbs; First I would emphasize that metformin does not exactly falsely elevate lactate levels; it has been shown to actually elevate levels as part of gluconeogenesis from several sources. What is more likely is a coincidental lactate elevation in the face of infection.
I would caution however based on reason and experience; in the face of infection with lactate elevation, think horses not zebras. A mortality review of a 39 yo female with DM showed that a lactate elevation was ignored because "oh, the patient is on metformin". The next day the patient was dead from intractable septic shock . When dealing with infection and possible sepsis, "when in doubt, rule it out". Never dismiss an elevated lactate until you can PROVE that it is not cause by hypoperfusion from a serious illness, most often but not always, sepsis. There are several publications that address the metformin/lactate issue - a simple lit search will provide many. As you may have discovered many are not definitive. See below - this also has several cross-referenced papers: [cid:[email protected]] Thanks, MARY ANN BARNES-DALY MS RN CCRN DC | Clinical Performance Improvement Consultant Quality & Clinical Effectiveness Team | Office of Patient Experience Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833 Mobile 916.200.5604| [email protected] "You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete." ~R. Buckminster Fuller From: Sepsisgroups [mailto:[email protected]] On Behalf Of Gibbs, Katie Sent: Thursday, March 09, 2017 10:08 AM To: [email protected] Subject: [**External**] [Sepsis Groups] lactic acid WARNING: This email originated outside of the Sutter Health email system! DO NOT CLICK links if the sender is unknown and never provide your User ID or Password. Has anyone found any good evidence based practice related to Metformin falsely elevating Lactic Acid Levels ? Thank you, Katie Gibbs, RN, BSN Quality Improvement Specialist Witham Health Services PH 765-485-8459 [cid:[email protected]] CONFIDENTIALITY NOTICE: The information in this e-mail, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and legally privileged information. If you are not the intended recipient, any disclosure, copying, distribution or use of the contents of this information in any manner is strictly prohibited and may be unlawful. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Buss, Gerri Sent: Wednesday, March 08, 2017 10:43 AM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] Sepsis screening and treatment in Nursing Homes I am wondering if anyone has developed a sepsis screening and treatment process/algorithm for their nursing home population? If so would you be willing to share what you have done? Gerri Buss MS, RN Performance Excellence Consultant Blessing Hospital Quincy,Il. 62305 217-223-8400 Ext 6894 [email protected]<mailto:[email protected]> The information contained in this e-mail message is PRIVILEGED AND CONFIDENTIAL and is intended for the use of the addressee and no one else. If you are not the intended recipient, please do not read, distribute, reproduce or use this e-mail message (or the attachments). Please delete the original and notify the sender of the mistaken transmission. Thank you.
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