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Icd 10 Code For Anion Gap Metabolic Acidosis

High Anion Gap Metabolic Acidosis

High Anion Gap Metabolic Acidosis

When acidosis is present on blood tests, the first step in determining the cause is determining the anion gap. If the anion gap is high (>12 mEq/L), there are several potential causes. High anion gap metabolic acidosis is a form of metabolic acidosis characterized by a high anion gap (a medical value based on the concentrations of ions in a patient's serum). An anion gap is usually considered to be high if it is over 12 mEq/L. High anion gap metabolic acidosis is caused generally by acid produced by the body,. More rarely, high anion gap metabolic acidosis may be caused by ingesting methanol or overdosing on aspirin.[1][2] The Delta Ratio is a formula that can be used to assess elevated anion gap metabolic acidosis and to evaluate whether mixed acid base disorder (metabolic acidosis) is present. The list of agents that cause high anion gap metabolic acidosis is similar to but broader than the list of agents that cause a serum osmolal gap. Causes[edit] Causes include: The newest mnemonic was proposed in The Lancet reflecting current causes of anion gap metabolic acidosis:[3] G — glycols (ethylene glycol & propylene glycol) O — oxoproline, a metabolite of paracetamol L — L-lactate, the chemical responsible for lactic acidosis D — D-lactate M — methanol A — aspirin R — renal failure K — ketoacidosis, ketones generated from starvation, alcohol, and diabetic ketoacidosis The mnemonic MUDPILES is commonly used to remember the causes of increased anion gap metabolic acidosis.[4][5] M — Methanol U — Uremia (chronic kidney failure) D — Diabetic ketoacidosis P — Paracetamol, Propylene glycol (used as an inactive stabilizer in many medications; historically, the "P" also stood for Paraldehyde, though this substance is not commonly used today) I — Infectio Continue reading >>

Diabetes Classification Integral To Hospital Quality Measurement, Correct Code Capture

Diabetes Classification Integral To Hospital Quality Measurement, Correct Code Capture

Every year, the government updates the ICD-9-CM codes we use to report illnesses. This year, effective October 1, ICD-9-CM introduces a bevy of new codes, including a new category for secondary diabetes mellitus and its complications. Reporting these codes to specify the etiology of diabetes increases our patients’ illness severity in risk adjustment physician and hospital profiling algorithms. Further, when we fail to document diabetic ketoacidosis (DKA) or hyperosmolarity of any cause as being present on admission (POA), Medicare will deem this a hospital-acquired condition (HAC), potentially disqualifying additional hospital reimbursement. Deep venous thrombosis, pulmonary embolus, and certain postoperative orthopedic wound infections are affected similarly. Ask your coding or quality manager for more information on HACs so you can consider their POA status as you document them. Definitions and criteria are crucial The clinical criteria for diabetes mellitus include: Two or more fasting blood glucoses greater than 126 mg/dl Symptoms of diabetes (e.g., polyuria or polydipsia) with a random blood glucose greater than 200 mg/dl A two-hour blood glucose greater than 200 mg/dl during an oral glucose tolerance test Criteria for gestational diabetes are stricter. Pregnant women require only a fasting blood glucose greater than 95 mg/dl at 24–28 weeks of gestation to make this diagnosis. Many physicians and ICD-9-CM categorize hyperglycemic states as follows: Hyperglycemia (code 790.29), impaired fasting glucose (code 790.21), or impaired glucose tolerance test (code 790.22) indicate only an elevated blood glucose. Although severe hyperglycemic states (glucose greater than 250 mg/dl) are associated with increased morbidity or mortality, code 790.29 does not have the same Continue reading >>

Hypernatremia Diagnosis

Hypernatremia Diagnosis

@ Diabetes Insipidus Hypernatremia Diabetes Differential Diagnosis The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days. Hypernatremia is defined as plasma sodium concentration of >145 mEq/L. @ Diabetes Insipidus And Hypernatremia Type 1 Diabetes Symptoms Toddler The 3 USMLEVideoLectures 26,150 views. Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. 33 Hypernatremia and hyperbilirubinemia each cause central nervous system depression among infants with lethargy, poor suck, and anorexia. When fluid is lost and not replaced, sodium is not adequately excreted from the body. Diagnosis and Management of Sodium Disorders: Hyponatremia and Hypernatremia MICHAEL M. BRAUN, DO, Madigan Army Medical Center, Tacoma, Washington 2000 May 1;107(5):75-82; quiz 179. Hypernatremia diagnosis - one cause of hypernatremia in children is intentional administration as a form of Munchausen Syndrome by Proxy. [10844943] Kang SK, Kim W, Oh MS. Hyponatremia and hypernatremia. Adeleye O, Faulkner M, Adeola T, ShuTangyie G. Hypernatremia in the elderly. 34, March 1, 2015 Volume 91, Number 5 www.aafp.org/afp American Family Physician 299 Diagnosis and Management of Sodium Disorders: Hyponatremia and Hypernatremia Mount, MD, Associate Chief a, b, * a Renal Division, Brigham and 2002 Aug;94(8):701-5. Hyponatremia: Causes, Diagnosis, Treatment - Duration: 8:59. A systematic approach to causes and their correction. Diagnostic approach. Hypernatremia is a common electrolyte problem and is defined as a rise in serum sodium concentration to a value exceeding 145 mmol/L. Search within a content type, and even narrow to one or more resources. Symptom Checker. @ Diabetes Insipidus And Hypernatremia Diagnosis Of Type 2 Diabetes The 3 Step Trick Continue reading >>

Sample Questions For Naplex Exam.

Sample Questions For Naplex Exam.

115. How one should take Rybelsus? [Select All That Apply] a. Take on an empty stomach when you first wake up. b. Take with no more than 4 ounces of plain water. c. Wait at least 30 minutes before eating, drinking, or taking other oral medications. d. It works best if you take Rybelsus 5 minutes before taking the meal. 115. How one should take Rybelsus? [Select All That Apply] a. Take on an empty stomach when you first wake up. b. Take with no more than 4 ounces of plain water. c. Wait at least 30 minutes before eating, drinking, or taking other oral medications. d. It works best if you take Rybelsus 5 minutes before taking the meal. Answer: (a,b,c) The active ingredient found in Rybelsus is Semaglutide. It is a glucagon-like peptide 1 (GLP-1) receptor agonist indicated as: 1. an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. 1. Take on an empty stomach when you first wake up. 2. Take with no more than 4 ounces of plain water. 3. Wait at least 30 minutes before eating, drinking, or taking other oral medications. Instruct patients to take Rybelsus (Semaglutide) at least 30 minutes before the first food, beverage, or other oral medications of the day with no more than 4 ounces of plain water only. Waiting less than 30 minutes, or taking with food, beverages (other than plain water) or other oral medications will lessen the effect of Rybelsus (Semaglutide). Waiting more than 30 minutes to eat may increase the absorption of Rybelsus (Semaglutide). Swallow tablets whole. Do not cut, crush, or chew tablets. Start Rybelsus (Semaglutide) with 3 mg once daily for 30 days. After 30 days on the 3 mg dose, increase the dose to 7 mg once daily. Dose may be increased to 14 mg once daily if additional glycemic control is needed after Continue reading >>

Phass 7110 Study Guide (2014-15 Paxton) - Instructor Paxton At Marquette University - Studyblue

Phass 7110 Study Guide (2014-15 Paxton) - Instructor Paxton At Marquette University - Studyblue

also how we get paid and want to avoid delay in payment before 1983- insurance co decided which coding system it accepted 1983- Medicare created a new coding system- HCPCS billing code- reimbursed for what was done incorporate greater clinical detail and specificity into the codes are updated to reflect current medical understanding and classification of diseases codes are a series of 3-5 numbers, the lasat two numbers are separated by a decimal codes are divided into 17 primary chapters within each chapter, codes are organized into 3 digit categories subclassification codes give additional specificity and clarification the coder has specific information about the diagnosis that is not an option in the choice of ICD-9 codes used when the coder does not have enough information to select a more definitive diagnosis code to the highest level of certainty at that visit only code the reason for the encounter and those conditions that affect the care delivered use the most specific code available (4th digit for diabetes is whether it is controlled) do not use rule out or suspected diagnosis while coding use a code from the symptoms, signs and ill defined conditions classification used to deal with occasions when circumstances other than a disease or injury are recorded as diagnoses or problems ex of when a person who is not currently sick encounters the health services for a specific purpuse discuss a problem that is not an illness or injury when a person with a known dx encounters the healthcare system for a specific tx of that disease or injury dialysis for renal dx, chemotherapy for malignancy, cast change form used by medical practitioners that can be quickly completed and submitted to an insurance co or employer for reimbursement important to remember with ICD-10 and do Continue reading >>

Search Page 1/10: Metabolic Acidosis

Search Page 1/10: Metabolic Acidosis

Arthropathy assoc w metabolic disorder; Arthropathy due to a metabolic disorder; Arthropathy due to metabolic disorder; Arthropathy with metabolic disorder; Bilateral corneal deposits in metabolic disorders; Cardiomyopathy, metabolic; Corneal deposit associated with metabolic disorder; Corneal deposits in metabolic disorders; Corneal deposits in metabolic disorders, both eyes; Enzymopathy; Inborn error of metabolism; Left corneal deposits in metabolic disorders; Metabolic cardiomyopathy; Metabolic disease; Metabolism disorder; Multiple carboxylase deficiency; Right corneal deposits in metabolic disorders 2016 2017 2018 Non-Billable/Non-Specific Code P19.0 Metabolic acidemia in newborn first noted bef... P19.1 Metabolic acidemia in newborn first noted dur... Encounter for screening for other metabolic disorders Screening for endocrine, nutritional, metabolic and immunity disorders done; Screening for endocrine, nutritional, metabolic, and immunity disorders; Screening for metabolic disease; Screening for metabolic disorder done Encounter for screening for other metabolic disorders 2016 2017 2018 Billable/Specific Code POA Exempt Drug resistance to insulin; Dysmetabolic syndrome x; Insulin resistance; Metabolic syndrome x; Dysmetabolic syndrome X; codes for associated manifestations, such as:; obesity (E66.-) Corneal deposits in metabolic disorders, unspecified eye Corneal deposit associated with metabolic disorder; Corneal deposits in metabolic disorders Corneal deposits in metabolic disorders, unspecified eye Corneal deposits in metabolic disorders, right eye Right corneal deposits in metabolic disorders Corneal deposits in metabolic disorders, right eye Corneal deposits in metabolic disorders, left eye Left corneal deposits in metabolic disorders Corneal deposits in m Continue reading >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

Increased production of ketone bodies due to: Dehydration (nausea/vomiting, ADH inhibition) leads to increased stress hormone production leading to ketone formation Depleted glycogen stores in the liver (malnutrition/decrease carbohydrate intake) Elevated ratio of NADH/NAD due to ethanol metabolism Increased free fatty acid production Elevated NADH/NAD ratio leads to the predominate production of β–hydroxybutyrate (BHB) over acetoacetate (AcAc) Dehydration Fever absent unless there is an underlying infection Tachycardia (common) due to: Dehydration with associated orthostatic changes Concurrent alcohol withdrawal Tachypnea: Common Deep, rapid, Kussmaul respirations frequently present Nausea and vomiting Abdominal pain (nausea, vomiting, and abdominal pain are the most common symptoms): Usually diffuse with nonspecific tenderness Epigastric pain common Rebound tenderness, abdominal distension, hypoactive bowel sounds uncommon Mandates a search for an alternative, coexistent illness Decreased urinary output from hypovolemia Mental status: Minimally altered as a result of hypovolemia and possibly intoxication Altered mental status mandates a search for other associated conditions such as: Head injury, cerebrovascular accident (CVA), or intracranial hemorrhage Hypoglycemia Alcohol withdrawal Encephalopathy Toxins Visual disturbances: Reports of isolated visual disturbances with AKA common History Chronic alcohol use: Recent binge Abrupt cessation Physical Exam Findings of dehydration most common May have ketotic odor Kussmaul respirations Palmar erythema (alcoholism) Lab Acid–base disturbance: Increased anion gap metabolic acidosis hallmark Mixed acid–base disturbance common: Respiratory alkalosis Metabolic alkalosis secondary to vomiting and dehydration Hyperchlorem Continue reading >>

Icd-10 Chapter Iv: Endocrine, Nutritional And Metabolic Diseases

Icd-10 Chapter Iv: Endocrine, Nutritional And Metabolic Diseases

ICD-10 Chapter IV: Endocrine, nutritional and metabolic diseases Certain infectious and parasitic diseases Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism Endocrine, nutritional and metabolic diseases Diseases of the skin and subcutaneous tissue Diseases of the musculoskeletal system and connective tissue Certain conditions originating in the perinatal period Congenital malformations, deformations and chromosomal abnormalities Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified Injury, poisoning and certain other consequences of external causes External causes of morbidity and mortality Factors influencing health status and contact with health services The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). [1] This page contains ICD-10 Chapter IV: Endocrine, nutritional and metabolic diseases. This is an overview about the chapter IV (also called chapter E) of the International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10). This chapter is about Endocrine, nutritional and metabolic diseases. [2] The ICD-10 is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). The code set allows more than 155,000 different codes and permits tracking of many new diagnoses and procedures , a significant expansion on the 17,000 codes available in ICD-9 . [3] Continue reading >>

Acidosis, Leukopenia, Levamisole: Causes & Diagnoses | Symptoma.com

Acidosis, Leukopenia, Levamisole: Causes & Diagnoses | Symptoma.com

The acute neonatal phenotype usually presents within the first 2 weeks of life with poor feeding, vomiting, decreased levels of consciousness, seizures, acidosis and hyperammonemia [genedx.com] [] glucose disturbances, hyperammonemia, hypocalcemia, and nonanion gap metabolic acidosis. [journals.lww.com] 2016 2017 2018 Billable/Specific Code Applicable To Acidosis NOS Lactic acidosis Metabolic acidosis Respiratory acidosis Type 1 Excludes diabetic acidosis - see categories [icd10data.com] Acidosis 270.3 Disturbances of branched-chain amino-acid metabolism, Disturbances of metabolism of leucine, isoleucine, and valine, Hypervalinemia Intermittent branched-chain [genedx.com] [] decompensation with metabolic acidosis and brain injury during periods of catabolism. [journals.lww.com] 2016 2017 2018 Billable/Specific Code Applicable To Acidosis NOS Lactic acidosis Metabolic acidosis Respiratory acidosis Type 1 Excludes diabetic acidosis - see categories [icd10data.com] The primary concern for the anesthesiologist is to avoid events that precipitate metabolic acidosis. [journals.lww.com] Acidosis 277.8 Other specified disorders of metabolism References Desviat et al., (2009) Mol Genet Metab 96:171-176 Desviat, L.R. et al (2006) J Hum Genet 51:992-997 Desviat [genedx.com] New code (first year of non-draft ICD-10-CM) 2017 (effective 10/1/2016) : No change 2018 (effective 10/1/2017) : No change Acidemia E87.2 ICD-10-CM Diagnosis Code E87.2 Acidosis [icd10data.com] Anesthetic strategies should be designed to avoid metabolic acidosis and prevent airway complications. [journals.lww.com] Metabolic acidosis in the critically ill: part 2. [lifeinthefastlane.com] The metabolic acidosis caused by RTA is a normal anion gap acidosis . [en.wikipedia.org] This results in a hyperchloraemic me Continue reading >>

Ketoacidosis Icd 10 Code

Ketoacidosis Icd 10 Code

Ketoacidosis icd 10 code. ICD-10 Codes Diagnosis Grouping; ICD-10 Codes: Diagnosis: Grouping: H00012: Hordeolum externum right lower eyelid: Eyelids: H00013: Hordeolum externum right eye. Type 1 diabetes mellitus with ketoacidosis without coma. 2016 2017 2018 Billable/Specific Code. E10.10 is a billable/specific ICD-10-CM code that can be used to. Diagnosis Code E10.9 information, including descriptions, synonyms, code edits, diagnostic related groups, ICD-9 conversion and references to the diseases index. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal. Free, official info about 2015 ICD-9-CM diagnosis code 707.10. Includes coding notes, detailed descriptions, index cross-references and ICD-10-CM conversion info. ICD 10 lookup. Search ICD 10 codes for NECK PAIN. 2018 ICD-10 code lookup What is the ICD-10 codes for type 1 and 2 diabetes? Part of Dr. Gily's icd-10 codes training tools. 3 ICD-10-CM Diabetes: Combine Coding and Documentation for Greater Specificity AN HCPRO WEBCAST PRESENTED ON June 15, 2015 We will begin shortly!. How To Treat Peripheral Neuropathy? What Is Peripheral Neuropathy, And What Are Its Symptoms?. 2018 ICD-10-CM E13.10 Other specified diabetes mellitus with ketoacidosis without coma; Note: approximate conversions between ICD-9-CM codes and ICD-10-CM codes may. Does apple cider vinegar stop your period Type 2 diabetes mellitus with ketoacidosis without coma. 2018 - New Code Billable/Specific Code. E11.10 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. ICD-10-CM E11.10 is a new 2018 ICD-10-CM code that became effective on October 1, 2017. This is the. Approximate Synonyms. Dia Continue reading >>

Icd-9-cm Diagnosis Code 276.2 : Acidosis

Icd-9-cm Diagnosis Code 276.2 : Acidosis

Metabolic acidosis, increased anion gap (IAG) (met-ah-bol-ik as-id-o-sis) a condition in which the blood is too acidic. It may be caused by severe illness or sepsis (bacteria in the bloodstream) A disorder characterized by abnormally high acidity (high hydrogen-ion concentration) of the blood and other body tissues A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up A state due to excess retention of carbon dioxide in the body Acidosis caused by accumulation of lactic acid more rapidly than it can be metabolized; may occur spontaneously or in association with diseases such as diabetes mellitus, leukemia, or liver failure Acidosis resulted from any pathologic condition interfering with normal ventilation, e.g. In case of chronic obstructive pulmonary disease An abnormal increase in the acidity of the body's fluids An abnormally high acidity (excess hydrogen-ion concentration) of the blood and other body tissues An abnormally high acidity of the blood and other body tissues. Acidosis can be either respiratory or metabolic Excess retention of carbon dioxide in the body resulting from ventilatory impairment Pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate) content of the blood and body tissues, and characterized by an increase in hydrogen ion concentration (decrease in ph) Continue reading >>

2018 Icd-10-cm Diagnosis Code

2018 Icd-10-cm Diagnosis Code

A condition in which the blood is too acidic. It may be caused by severe illness or sepsis (bacteria in the bloodstream). A disorder characterized by abnormally high acidity (high hydrogen-ion concentration) of the blood and other body tissues. A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. A state due to excess retention of carbon dioxide in the body. Acid base imbalance resulting from an accumulation of carbon dioxide secondary to hypoventilation. Acidosis caused by accumulation of lactic acid more rapidly than it can be metabolized. It may occur spontaneously or in association with diseases such as diabetes mellitus, leukemia, or liver failure. Acidosis caused by accumulation of lactic acid more rapidly than it can be metabolized; may occur spontaneously or in association with diseases such as diabetes mellitus, leukemia, or liver failure. An abnormal increase in the acidity of the body's fluids An abnormally high acidity (excess hydrogen-ion concentration) of the blood and other body tissues. An abnormally high acidity of the blood and other body tissues. Acidosis can be either respiratory or metabolic. Excess retention of carbon dioxide in the body resulting from ventilatory impairment. Increased acidity in the blood secondary to acid base imbalance. Causes include diabetes, kidney failure and shock. Metabolic acidosis characterized by the accumulation of lactate in the body. It is caused by tissue hypoxia. Pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate) content of the blood and body tissues, and characterized by an increase in hydrogen ion concentration (decrease in ph). Respi Continue reading >>

Icd-11 Beta Draft - Mortality And Morbidity Statistics

Icd-11 Beta Draft - Mortality And Morbidity Statistics

This functionality is availabe after you log in to the system You may click the [Log In] link to sign in to the system. If you don't already have an account, it's very easy to setup one using the same link. A linearization is a subset of the foundation component, that is: Fit for a particular purpose: reporting mortality, morbidity, or other uses Jointly Exhaustive of ICD Universe (Foundation Component) Composed of entities that are Mutually Exclusive of each other Linearizations are similar to the classical print versions of ICD Tabular List (e.g. volume I of ICD-10 or other previous editions). Various linearizations could be built at different granularity, use case or other purposes such as for Primary Care, Clinical Care or Research. The linkage from the foundation component to a particular linearization will ensure consistent use of the ICD. This functionality is availabe after you log in to the system You may click the [Log In] link to sign in to the system. If you don't already have an account, it's very easy to setup one using the same link. NEWS: We have new training videos on the ICD-11 Browser. You can browse the ICD-11 proposed content here If you wish to participate in the Beta Phase you may create an account for yourself from by registering to the ICD-11 Browser. Registering will provide you additional functionality such as accessing print materials, commenting, making change proposals, receiving notifications, etc. NOT TO BE USED for CODING except for agreed FIELD TRIALS For more information about how to use the ICD-11 Browser, please see the User Guide For more questions, please contact [email protected] When visualizing the foundation, all nodes look the same except the selected entity which has a darker background and larger circle. In this example the Inter Continue reading >>

Orphanet: Propionic Acidemia

Orphanet: Propionic Acidemia

The prevalence rate is probably about 1 in 100,000 live births worldwide. A high prevalence rate is noted in certain countries like Saudi Arabia. Propionic acidemia can present in one of the following forms: severe neonatal onset, intermittent late onset or a chronic progressive form. In the severe neonatal onset form, the affected infants present with symptoms of metabolic intoxication (poor feeding, vomiting, altered sensorium) and pancytopenia within several hours to weeks after birth. In the intermittent late onset form, the disease presents after a year or even later in life with episodes of metabolic decompensation provoked by periods of catabolic stress like fever, vomiting and trauma. Patients may also present with acute neurological crisis characterized by dystonia, rigidity, choreoathetosis and dementia (due to infarction of basal ganglia). In the chronic progressive form, the disease presents as failure to thrive, chronic vomiting, psychomotor delay, hypotonia, seizures and movement disorders. Intellectual disability, optic neuropathy, cardiomyopathy, long QT syndrome, pancreatitis, dermatitis, and immune dysfunction are known complications. PA is caused by mutations in either the PCCA (13q32) or PCCB (3q21-q22) genes encoding the - and -subunits of the propionyl CoA carboxylase. Extended newborn screening test identifies PA by detecting an elevated level of propionyl carnitine. Symptomatic cases present during metabolic decompensation with acidosis, ketosis, increased anion gap, hyperlactatemia, hyperglycinemia, hyperammonemia, hypoglycemia and cytopenias. Urine analysis by gas chromatography-mass spectrometry reveals a characteristic pattern with 3 hydroxy propionate, methyl citrate, propionyl glycine and propionyl carnitine that persists in between crisis Continue reading >>

Case Of The Month 15 Answer

Case Of The Month 15 Answer

A 44 year-old female presented to the emergency department with 3 days of nausea, vomiting, diarrhea, and left lower quadrant pain. She has a history of diabetes and stage 3 CKD and is taking metformin and enalapril. On exam, she is found to be tachycardic and borderline tachypneic. She is speaking full sentences and has hyperactive bowel sounds with left lower quadrant tenderness but no rebound or guarding and a normal pelvic exam. Her labs are notable for hypokalemia, elevated lactate, and a small bump in her creatinine from baseline. Her urinalysis is normal, and she is HCG negative. Explain the patients metabolic acidosis? This is an anion gap (21) metabolic acidosis in a patient who takes metformin with an acute kidney injury and elevated lactate. Could this be metformin-associated lactic acidosis (MALA)? In order to diagnose MALA, you first have to believe it exists. The mechanism of metformin is complex and not fully understood. It is believed to work in 2 ways. Firstly, it converts glucose into lactate. Secondly, metformin decreases gluconeogenesis inhibiting lactate and pyruvate conversion back to glucose. Metformin is eliminated via the kidneys, and the concern is that in patients with ESRD, it may accumulate to toxic doses. After reviewing the literature, it appears this is unlikely. Yes, it is cleared by the kidney, but does not result in toxic blood levels of metformin (Frid et al, 2010). Additionally, research shows that it leads to increased blood lactate levels but does not translate to an increase in lactic acidosis. This fear of metformin stems from the original biguanide, phenphormin. Ultimately removed from the market in 1970s, it has been shown to cause significant lactic acidoses, because it is both hepatic and renally cleared, more lipophilic, an Continue reading >>

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