Metformin poisoning and lactic acidosis has always been murky. For years there was debate about whether metformin-induced lactic acidosis exists (short answer: it obviously does). However, for an individual patient, it can still be confusing sorting out the contribution of metformin to their critical illness. A recent re-definition of the condition clarifies things a bit, but substantial confusion persists regarding how to diagnose and treat these patients.
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