Metformin toxicity should be considered in any patient with type 2 diabetes mellitus presenting with severe lactic acidosis and profound acidemia.

Metformin-associated lactic acidosis can be treated with renal replacement therapy and generally has a higher survival rate than other causes of severe lactic acidosis.

Metformin should be used with caution in patients with chronic kidney disease. Education of patients with type 2 diabetes and their healthcare providers is crucial to avoid metformin-associated lactic acidosis when there is a risk of renal failure.