![]() ![]() A comprehensive literature search performed by Salpeter et al. An estimated incidence of metformin-induced lactic acidosis (MALA) is 6.3 per 100,000 patient-years . Commonly reported adverse effects include gastrointestinal symptoms such as diarrhea and abdominal cramps lactic acidosis remains a recognized but rare complication. It is considered cost effective as well as safe given lack of hypoglycemia as a side effect. Metformin is currently recommended as a first-line agent in the management of type 2 diabetes in association with lifestyle modifications by the American Diabetes Association. Early recognition allows timely initiation of appropriate therapy and reduces associated morbidity. Commonly encountered clinical scenarios such as hypoxemia, sepsis, alcohol abuse, renal injury, and shock can precipitate MALA. Risk of metformin-associated lactic acidosis (MALA) is reported to be an estimated 6.3 per 100,000 patient-years. She required emergent dialysis but subsequently, renal functions recovered. Serum metformin levels were high at 14 mcg/mL (therapeutic range: 1-2 mcg/mL). We present the case of a 42-year-old lady with type 2 diabetes mellitus who required initial admission to intensive care unit (ICU) after presenting with unilateral back and lower abdominal pain with dysuria and was noted to have an acute kidney injury with a creatinine of 7.45 mg/dL and severe metabolic acidosis with a pH of 6.7 and an anion gap more than 50 mmol/L. As a result, it remains essential that all medical professionals be aware of any adverse effects as a result of metformin therapy, no matter how uncommon. Hence, not surprisingly, metformin is a commonly prescribed medication by most healthcare providers in all clinical settings. ![]() In addition to lifestyle changes, the American Diabetes Association recommends metformin as the first-line treatment for type 2 diabetes. According to the National Diabetes Statistics Report (2017) by Centers for Disease Control and Prevention (CDC), 9.4% of the US population, approximately 30.3 million people had diabetes while 84.1 million had pre-diabetes as of 2015.
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