(see full publication)

General Recommendation

  • ECTR is recommended in severe metformin poisoning (1D)



ECTR is indicated if ANY of the following conditions are present:

  • Lactate concentration greater than 20 mmol/L (1D)

  • pH less than or equal to 7.0 (1D) 

  • Shock (1D)

  • Failure of standard supportive measures (1D)

  • Decreased level of consciousness (2D)


Cessation of ECTR is indicated when

  • Extracorporeal treatment should be continued until the lactate concentration is less than 3 mmol/L (1D)  


  • pH greater than 7.35 (1D), at which time close monitoring is warranted to determine the need for additional courses of extracorporeal treatment. 


Choice of ECTR

  • Intermittent hemodialysis is preferred initially (1D)

  • Continuous renal replacement therapies may be considered if hemodialysis is unavailable (2D)

  • Repeat extracorporeal treatment sessions may use hemodialysis (1D) or continuous renal replacement therapy (1D).​