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A rare but serious metabolic emergency — the reason metformin is stopped at advanced eGFR.
Lactic acidosis (blood lactate > 5 mmol/L with pH < 7.35) is a medical emergency with high mortality. Metformin-associated lactic acidosis is rare in current practice because metformin is dose-adjusted and stopped at eGFR < 30, and held during acute illness. Symptoms include deep breathing, confusion, abdominal pain, and shock.
The first-line diabetes drug — safe in early-mid CKD with dose adjustment, stopped at advanced stages due to lactic acidosis risk.
A build-up of acid from failing kidneys (reduced bicarbonate) - common in advanced CKD and a treatable driver of progression.
A sudden drop in kidney function over hours to days - reversible if caught early, but a major risk factor for chronic kidney disease.
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This content is a general reference, not medical advice, a diagnosis, or a treatment plan. Do not change your diet, fluids, medicines, or dialysis plan without your nephrologist or renal dietitian. Individual recommendations depend on your labs, medications, conditions, and care plan.