A 75-year-old client on chronic metformin 1000 mg orally twice daily presents with new muscle aches, fatigue, abdominal pain, hyperventilation, and Kussmaul respirations. Vitals: BP 92/58, HR 110, temp 35.6°C. Labs: serum lactate 9 mmol/L (normal

• 1 Administer oral charcoal 50 g and observe for 2 hours.
• 2 Hold metformin immediately, prepare for IV fluid resuscitation, anticipate transfer to ICU and possible hemodialysis to remove metformin and correct severe lactic acidosis, monitor airway/respiratory status closely, and notify the provider; consider IV sodium bicarbonate per protocol for severe acidemia. ✓ Correct answer
• 3 Give a fluid bolus of D10W to raise blood pressure.
• 4 Continue metformin and add an additional dose because the client is hypoglycemic.

For study reference only. Always follow current clinical guidelines and your institution’s protocols.