Emergence Teleradiology Metformin Recommendations

Patients currently taking Metformin for control of Diabetes can be placed into one of 3 categories for management related to IV contrast usage based on baseline renal function and known comorbidities

Category I
Patients with normal renal function and no known comorbidities (below) there is no need to discontinue metformin prior to IV contrast administration.

Category II
Patients with normal renal function and any of below comorbidities then Metformin should be discontinued at time of IV contrast administration and withheld for 48 hours.

Category III
Patients with renal dysfunction metformin should be discontinued at time of IV contrast administration with renal function and patient reevaluated by ordering clinician prior to reinstituting Metformin usage.

Comorbidities for Lactic Acidosis with Metformin Use

  1. Liver dysfunction (cirrhosis or hepatic failure)
  2. Alcohol abuse
  3. Cardiac failure
  4. Myocardial or peripheral ischemia (recent heart attack or occluded peripheral artery)
  5. Sepsis or severe infection