Metformin is a widely used antidiabetic agent that is generally considered safe. Reported here is a fatal case of acute metformin overdose in a 73-year-old male patient. The rapid clinical deterioration is described to illustrate the possible severity of toxicity. It is followed by a literature review on the topics concerning acute metformin intoxication. Pathogenesis and clinical features on metformin-associated lactic acidosis, as well as the current recommendations in management are discussed in details.
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