Successful management of high-dose metformin intoxication. Role of vasopressin in the management of severe lactic acidosis.

On induction of anesthesia (for intubation), the patient hemodynamics became very unstable prompting the initiation of both Epinephrine and Nor-Epinephrine Intra-venous (IV) infusions. Glucose 10% IV infusion and Insulin IV infusion were also started. The pre-transfer management also included Hydrocortisone IV justified by the marked hemodynamic instability and mediocre response to inotropic support. Arterial Blood Gas (ABG) analysis showed severe acidosis and Lactate level of 34 mmol/l, in addition to a Hyperkalemia of 7 mmol/l. He was then transferred to our Intensive Care Unit (ICU) to start Continuous Veno-Venous Hemofiltration (CVVH).