Acute and chronic use of<unk>  can lead to rare complication of<unk>  (MALA)
Excreted (unmetabolized) in proximal tubules
Stimulates anaerobic glucose metabolism in splanchnic bed → increased lactate production
Inhibits mitochondrial respiratory chain → decreased gluconeogenesis from lactate → lactate accumulation<unk>  with overdose, renal failure, liver disease, and septicemia
Acidosis onset several hours after acute ingestion
Mortality rate 45%
Lactate only predictive of mortality in overdose patients, not in incidental<unk>  accumulation
Elevated PT<unk>  with increased mortality
pH >6.9, lactate >25 portends a poor prognosis
Lactate only predictive of mortality in overdose patients, not in incidental<unk>  accumulation
Elevated PT<unk>  with increased mortality
pH >6.9, lactate >25 portends a poor prognosis
Metformin-associated lactic acidosis
Type A 
Starvation ketoacidosis
Hypovolemia
Nonketotic hyperglycemia
Cardiac failure
Diabetic ketoacidosis
Sepsis