Metformin-Associated Lactic Acidosis Following Acute Overdose: Clinical Course and Conservative Management

Metformin is an antidiabetic medication that belongs to the class of oral hypoglycemic agents: Biguanides. Although its mechanism of action remains elusive, it is well established that metformin enhances insulin sensitivity and decreases hepatic gluconeogenesis. Metformin usually does not provoke hypoglycemia and is well tolerated. Despite this fact, metformin-associated lactic acidosis (MALA) remains one of the concerning side effects especially in the context of tissue hypoxia and pre-existing renal failure. Management usually involves maintenance of hemodynamic stability, correction of acidosis and even renal replacement therapy in refractory cases. This case report aims to improve understanding and clinical presentation of this infrequent entity and also highlights the importance of a robust diagnostic approach in the management of the same.