Metformin-associated lactic acidosis precipitated by acute renal failure

Metformin-associated lactic acidosis (MALA) is a rare but serious clinical entity. It is almost always seen in patients with a serious underlying medical disorder, most often a degree of renal impairment or other factors that are known to predispose to the lactic acidosis. We report a case of MALA in which acute renal failure resulting from hypovolemia secondary to acute gastroenteritis likely precipitated the condition. Early recognition of this condition and initiation of treatment are important. Bicarbonate hemodialysis is the treatment of choice.