[Acute blindness in a patient with metformin-associated lactic acidosis]

Lactic acidosis is a rare metabolic complication that can occur in patients with diabetes mellitus type 2 who use metformin. We discuss a 79-year old woman with metformin-associated lactic acidosis (MALA) and acute kidney injury based on gastroenteritis. Patient reported acute blindness which in literature is described as a rare presentation of a metabolic acidosis (regardless of its underlying cause). Immediate treatment with hemodialysis led to improvement of the acidosis and complete recovery of the vision. It is important that patients who use metformin are instructed to consult their health care provider and/or discontinue metformin in case of intercurrent diseases.