Syrine Keskes¹, Oumaima Arous², Héla Ben Turkia³, Raja Fadhel⁴, Amira Bekir⁵, Youssef EBN Ebrahim⁶, Sami Souissi⁷, Hanen Ghazali⁸

¹Ben Arous Regional Hospital, Emergency Department; 2063 Ben Arous, Tunisia. University of Tunis El Manar, Faculty of Medicine of Tunis; 1006 Tunis, Tunisia, ORCID ID: 0000-0002-4081-8814

²Ben Arous Regional Hospital, Emergency Department; 2063 Ben Arous, Tunisia. University of Tunis El Manar, Faculty of Medicine of Tunis; 1006 Tunis, Tunisia

³Ben Arous Regional Hospital, Emergency Department; 2063 Ben Arous, Tunisia. University of Tunis El Manar, Faculty of Medicine of Tunis; 1006 Tunis, Tunisia, ORCID ID: 0000-0002-3364-3067

⁴Ben Arous Regional Hospital, Emergency Department; 2063 Ben Arous, Tunisia. University of Tunis El Manar, Faculty of Medicine of Tunis; 1006 Tunis, Tunisia, ORCID ID: 0000-0003-4975-0999

⁵Ben Arous Regional Hospital, Emergency Department; 2063 Ben Arous, Tunisia. University of Tunis El Manar, Faculty of Medicine of Tunis; 1006 Tunis, Tunisia,

⁶Ben Arous Regional Hospital, Emergency Department; 2063 Ben Arous, Tunisia. University of Tunis El Manar, Faculty of Medicine of Tunis; 1006 Tunis, Tunisia, ORCID ID: 0000-0001-7713-8727

⁷Ben Arous Regional Hospital, Emergency Department; 2063 Ben Arous, Tunisia. University of Tunis El Manar, Faculty of Medicine of Tunis; 1006 Tunis, Tunisia, ORCID ID: 0000-0003-3295-2113

⁸Ben Arous Regional Hospital, Emergency Department; 2063 Ben Arous, Tunisia. University of Tunis El Manar, Faculty of Medicine of Tunis; 1006 Tunis, Tunisia, ORCID ID: 0000-0003-3103-3123

*Corresponding Author: Syrine Keskes, Ben Arous Regional Hospital, Emergency Department; 2063 Ben Arous, Tunisia. University of Tunis El Manar, Faculty of Medicine of Tunis; 1006 Tunis, Tunisia.

Citation: Syrine Keskes, Oumaima Arous, Héla Ben Turkia, Raja Fadhel, Amira Bekir, Youssef EBN Ebrahim, Sami Souissi, Hanen Ghazali (2025). Metformin-Induced Lactic Acidosis (MILA) with Acute Kidney Injury: Case Report. J Med Toxicol Clin Case Rep, 2(1),1-4.

Copyright: © 2025; Syrine Keskes, et al., This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

Abstract :

Introduction: Metformin-Induced Lactic Acidosis (MILA) is a rare but life-threatening condition, primarily occurring with high doses of metformin and in patients with impaired renal function. Observation: We present the case of a woman in her 60s with type 2 diabetes mellitus, who was treated with high doses of metformin and developed severe metabolic acidosis due to acute kidney injury (AKI). She presented with epigastric pain, vomiting, generalized fatigue and oliguria. Laboratory tests revealed acute kidney injury, profound lactic acidosis, and hyperkalemia. Renal ultrasound excluded a potential obstructive cause. Emergency management included electrolyte correction and hemodialysis, leading to gradual metabolic improvement. Conclusion: This case underscores the importance of adhering to therapeutic doses of metformin as well as monitoring renal function in diabetic patients on metformin therapy and underscores the need for early recognition and intervention in cases of MILA to prevent fatal outcomes.

Keywords: Metformin, Lactic Acidosis, Acute Kidney Injury, Hemodialysis.