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Metformin-Associated Lactic Acidosis Following Acute Overdose: Clinical Course and Conservative Management
Anil Yadav1, Sandeep Kandel1, Abhisek Jha1
1Department of Endocrinology Birat Medical College Teaching Hospital Morang Nepal.
Clinical Case Reports
|December 8, 2025
Summary
Metformin, a common antidiabetic drug, can rarely cause metformin-associated lactic acidosis (MALA), particularly with kidney issues or low oxygen. Prompt diagnosis and management are crucial for patient outcomes.
Area of Science:
- Pharmacology
- Internal Medicine
- Toxicology
Background:
- Metformin is a widely used oral hypoglycemic agent of the Biguanide class.
- Its precise mechanism involves enhancing insulin sensitivity and reducing hepatic gluconeogenesis.
- While generally safe and well-tolerated, it carries a risk of metformin-associated lactic acidosis (MALA).
Purpose of the Study:
- To enhance understanding of metformin-associated lactic acidosis (MALA).
- To detail the clinical presentation of this rare side effect.
- To emphasize the importance of a thorough diagnostic approach in managing MALA.
Main Methods:
- This is a case report.
- Review of clinical presentation and diagnostic findings.
- Discussion of management strategies.
Main Results:
- Metformin-associated lactic acidosis (MALA) is an infrequent but serious side effect.
- Risk factors include tissue hypoxia and renal failure.
- Management requires hemodynamic support, acidosis correction, and potentially renal replacement therapy.
Conclusions:
- Metformin-associated lactic acidosis (MALA) necessitates a high index of suspicion.
- Early and accurate diagnosis is critical for effective management.
- Robust diagnostic and therapeutic strategies are essential for favorable patient outcomes.
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