All right, so welcome back to the Internet

Polic Critical Care podcast.

I'm here with Adam Thomas.

And we're going to talk to you about metformin toxicity and whether or not it exists

in Mawa, Mila, Mila.

I don't know, man.

So that's something about that.

Traditionally, this was just metformin toxicity.

And it's more complicated than that and Josh has broken down

into something that's straightforward, something that's associated and then something that's

just an innocent bystander, that spectrum of metformin toxicity. So let's go straight to the

meat and potatoes because this is controversial. Some people say it doesn't exist. Other camps say

truly it is out there and toxicity is a clinically important thing to remember. It comes back to

basics, Josh. Let's go back to that glucose pyruvate creb cycle. Tell me what's going on here

at the cellular level. In super therapeutic slash overdose levels, metformin essentially poisons the mitochondria.

So this will shut down the crept cycle and cause metabolites to build up. It causes a build

up of pyruvate and that shunts into lactate. We see lactate because that's what we measure.

But the real problem here is that the whole cellular metabolism has just been shut down.

It's never a good thing when you mess with the mitochondrial transport chain, is it?

No, not at all.

I love your little mitochondria post here.

When somebody has a high lactate, always think about the mitochondria.

...