TY - JOUR T1 - Metformin-associated lactic acidosis JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2020-239154 VL - 14 IS - 7 SP - e239154 AU - Emma Jane Fadden AU - Christian Longley AU - Tushar Mahambrey Y1 - 2021/07/01 UR - http://casereports.bmj.com/content/14/7/e239154.abstract N2 - A 58-year-old female with known type 2 diabetes mellitus continued to take her usual medications, including metformin, an ACE inhibitor and a non-steroidal anti-inflammatory drug, while suffering from diarrhoea and vomiting. On presentation to the emergency department, she was found to have a profound lactic acidosis, cardiovascular instability and acute kidney injury. Despite a pH of 6.6, lactate of 14 mmol/L and a brief asystolic cardiac arrest, supportive treatment and the use of renal replacement therapy resulted in rapid improvement in her acid–base abnormalities and haemodynamic parameters. Metformin-associated lactic acidosis is a rare but life-threatening complication of diabetes management. Patient education and awareness amongst clinicians are paramount in the prevention and treatment of this condition. ER -