Metformin-associated lactic acidosis refractory to hemodialysis in the setting of concomitant alcohol intoxication

Metformin is currently the most frequently prescribed anti-diabetic drug worldwide. Metformin-associated lactic acidosis (MALA) is a rare but well documented side effect of metformin and can result in serious morbidity, and in rare cases, death. Severe lactic acidosis in the emergency department can have many different clinical presentations that compound the difficulty of MALA diagnosis and increase the mortality rate.