Metformin Associated Lactic Acidosis (MALA) after severe intentional intoxication: Delayed, yet full neurological recovery

Metformin is a widely used drug in the treatment of diabetes mellitus. In case of overdose, metformin can induce lactic acidosis and severe multiple organ failure. Despite very low pI I and high lactate levels on admission, patients usually recover within 48 hours when treated with fluids, dialysis, hemodynamic and respiratory support. We present a case of severe lactic acidosis after intentional ingestion of a high dose of metformin leading to seizures and prolonged coma yet finally resulting in full recovery.