Metformin-Related Acute Lactic Acidosis in a Woman with Normal Renal Function

Metformin is a first-line oral anti-hyperglycemic agent. It decreases insulin resistance, decreases hepatic glucose output, and enhances peripheral glucose uptake. Metformin is used as monotherapy or in combination with other oral hypoglycemic agents. A major toxicity of metformin is lactic acidosis. In the absence of acute overdose, metformin-associated lactic acidosis rarely develops in patients without comorbidities, such as renal or hepatic insufficiency or acute infection. Here we report a case of metformin-related lactic acidosis happening in a woman previously with a normal renal function. She was found to have acute renal injury and profound lactic acidosis after diarrhea for days. The conditions of lactic acidosis were corrected after two sessions of hemodialysis.