b'PACEP SCIENTIFIC ASSEMBLY 2024 CPC REVIEWThe Resolution:CPC CASE STUDY EMS brings an elderly woman who is a frequent flier from a nursing home with recurrent sepsis.RESULTSShe smells like a UTI.Test to order: metformin level, blood gas, patient historyDiagnosis: Metformin-associated Lactic acidosis (MALA)Patient course: patient was admitted to ICU and a sodium bicarbonate infusion was started. Patient also received HD/CRRT. The patient ultimately did well and was discharged back to SNF.Relevance to EM: This is a diagnosis that could be easily missed in a patient that cannot report a reliable history. Always review the patients medication list and consider MALA in patients with low bicarbonate levels, HAGMA and elevated lactate levels as MALA carries a high morbidity and mortality.Did You KnowTo learn more about open positions or to learn more about advertising a position, PACEP Has avisit the PACEP Website. Job Bank? CURRENT POSTINGS INCLUDE: NEW - Emergency Medicine PhysicianPenn Highlands DuBois NEW - Emergency Medicine System Quality Director in Pittsburgh, PA NEW - Emergency Medicine Medical Director in Monroeville, PA NEW - Emergency Medicine Physician - $80,000 Signing Bonus New - Neighborhood Hospitals Emergency MedicineNEW - Physician Executive - Chair, Department of Emergency Medicine, and Service Line Leader NEW - Emergency Medicine Physician - Hazleton22 PACEP News | Winter 2025'