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22nd June 2023
A 52-year-old woman with type 2 diabetes is sent into hospital by her GP having become increasingly unwell
A 52-year-old woman with type 2 diabetes is sent into hospital by her GP having become increasingly unwell over the last week with dysuria and flank pain, though she has still managed to continue to take her oral medications for her diabetes.
A venous blood gas shows:
| Result | Reference range | |
|---|---|---|
| pH | 7.293 | (7.35-7.45) |
| pCO2 | 4.9 kPa | (4.7-6 kPa) |
| Chloride | 96 mmol/L | (95-108 mmol/L) |
| Bicarbonate | 14.6 mmol/L | (22-29 mmol/L) |
| Base excess | -7 mEq/L | (-2 to +2 mEq/L) |
| Sodium | 134 mmol/L | (133-146 mmol/L) |
| Potassium | 3.2 mmol/L | (3.5-5.3 mmol/L) |
| Glucose | 9.4 mmol/L | |
| Lactate | 1.9 mmol/L | (0.5-2.2 mmol/L) |
Ketones were checked and found to be 2.6 mmol/L.
Which of the following medications is most likely to be contributing to her metabolic acidosis?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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