Der Internist
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In case of impaired consciousness, metabolic acidosis with wide anion gap and elevated lactate levels a metformin associated lactic acidosis should be considered in diabetic patients. Taking into account the contraindications to metformin, lactic acidosis is a rare complication, however - if it occurs - fatal in 50-80%. The outcome of the surviving patients is good, once the acute stage is outlived due to immediate hemofiltration.