If intubated, maintain minute ventilation so as to not remove respiratory compensation for acidosis
Activated charcoal if peri-ingestion/mental status appropriate<unk>  should not cause hypoglycemia and, if present, should lead to work up of cause
Sodium Bicarbonate
No evidence to support its use in MALA patients
Hemodialysis<unk>  can be cleared with hemodialysis and CVVH (continuous venovenous hemofiltration)
Former preferred
CVVH should be used in unstable patient
Reduction in<unk>  levels following acute ingestion reported to require prolonged HD
Consider if:
pH <7.1
Renal insufficiency
Mortality benefits mainly from improving acidosis than from removing<unk> 
No evidence to support its use in MALA patients<unk>  can be cleared with hemodialysis and CVVH (continuous venovenous hemofiltration)
Former preferred
CVVH should be used in unstable patient
Reduction in<unk>  levels following acute ingestion reported to require prolonged HD
Consider if:
pH <7.1
Renal insufficiency
Mortality benefits mainly from improving acidosis than from removing<unk> 
Former preferred
CVVH should be used in unstable patient
pH <7.1
Renal insufficiency
Metformin-associated lactic acidosis
Type A 
Starvation ketoacidosis
Hypovolemia
Nonketotic hyperglycemia
Cardiac failure
Diabetic ketoacidosis
Sepsis