Metformin, a commonly used biguanide antihyperglycemic agent, has a well-documented association with lactic acidosis. Most reported cases of metformin-related lactic acidosis were due to medication overdose or preexisting liver or kidney disease. In this case, a 62-year-old female with Type II diabetes mellitus, hypertension, and ischemic heart disease presented with decreased mentation, lactic acidosis, and acute kidney injury. Our patient had no history of kidney or liver disease. The patient developed the complication due to a therapeutic dose. Intravenous sodium bicarbonate was her initial treatment. As her condition did not improve, she underwent one session of hemodialysis, following which she dramatically improved. Eventually, we discharged the patient to her baseline status. In our experience, hemodialysis was very effective in managing metformin-associated lactic acidosis. We report this case to raise clinicians' awareness of this complication and to encourage hemodialysis as an early management option.

Metformin, a commonly used biguanide antihyperglycemic agent, has a well-documented association with lactic acidosis. Most reported cases of metformin-related lactic acidosis were due to medication overdose or preexisting liver or kidney disease. In this case, a 62-year-old female with Type II diabetes mellitus, hypertension, and ischemic heart disease presented with decreased mentation, lactic acidosis, and acute kidney injury. Our patient had no history of kidney or liver disease. The patient developed the complication due to a therapeutic dose. Intravenous sodium bicarbonate was her initial treatment. As her condition did not improve, she underwent one session of hemodialysis, following which she dramatically improved. Eventually, we discharged the patient to her baseline status. In our experience, hemodialysis was very effective in managing metformin-associated lactic acidosis. We report this case to raise clinicians' awareness of this complication and to encourage hemodialysis as an early management option.