Type II diabetes is a common disease worldwide and, metformin is one of the first line of drugs used in its treatment. Metformin elimination is mainly through the kidney; hence when the patient develops dehydration and acute kidney injury, it will lead to life-threatening lactic acidosis. Hemodialysis improves the patient's condition rapidly. We would like to present two patients who were on metformin and developed life-threatening lactic acidosis with hemodynamic instability following an episode of acute gastroenteritis and acute kidney injury. Hemodialysis hastened the recovery emphasizing the need for early identification and treatment.
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