# Life-Threatening Metformin-Induced Lactic Acidosis Associated With Euglycemic Ketoacidosis and Acute Multiorgan Dysfunction: A Case Report

## TL;DR

A 63-year-old woman with diabetes developed severe lactic acidosis and organ failure from metformin, requiring intensive treatment and recovery.

## Contribution

This case report highlights the rare but severe complication of metformin-associated lactic acidosis combined with euglycemic ketoacidosis and multiorgan dysfunction.

## Key findings

- The patient developed severe lactic acidosis (pH 6.77, lactate 20 mmol/L) and euglycemic ketoacidosis.
- Treatment included CVVHD, vasopressors, and ICU care, leading to full recovery.
- Early recognition and aggressive management, including RRT, were critical for survival.

## Abstract

Metformin-associated lactic acidosis (MALA) is a rare but life-threatening complication of metformin therapy. We present a case of a 63-year-old female with type 2 diabetes mellitus (on metformin and insulin) who developed severe lactic acidosis, euglycemic diabetic ketoacidosis (DKA), and acute kidney injury (AKI) following a three-day history of gastrointestinal symptoms. Despite initial stabilization efforts, the patient deteriorated into refractory shock and cardiac arrest, requiring intensive care unit (ICU) admission, continuous venovenous hemodiafiltration (CVVHD), vasopressor support, and mechanical ventilation. Serial arterial blood gas (ABG) analyses demonstrated profound metabolic acidosis (pH 6.77, lactate 20 mmol/L) with gradual normalization following CVVHD. The patient recovered fully, highlighting the importance of early recognition and aggressive management of MALA, including renal replacement therapy (RRT), in critically ill patients.