#212 Metformin-Associated Lactic Acidosis (MALA) Explained | Symptoms, Pathophys, Diagnosis & Management

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Previously titled “Metformin-Associated Lactic Acidosis (MALA) Explained | Symptoms, Pathophys, Diagnosis & Management” — renamed by the publisher on Aug 4, 2026

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Recorded30 Jan 2026

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Metformin-associated lactic acidosis (MALA) is rare, but when it occurs, it carries significant morbidity and mortality. In this episode, we walk through a practical, clinician-focused approach to recognizing and managing MALA in the emergency department and ICU. We review the pathophysiology behind metformin-related lactic acidosis, common risk factors and precipitating conditions, and the clinical features that should raise concern for MALA. We also discuss the diagnostic approach, key laboratory findings, and management strategies, including supportive care and considerations for dialysis. This episode is designed for emergency medicine and critical care clinicians, residents, and trainees who want a clear mental model for evaluating unexplained lactic acidosis in patients taking metformin. Link to YouTube Video: https://www.youtube.com/watch?v=4jmgU9u9Ba8 📚 Download the PDF study guide for this video: 👉 https://www.patreon.com/c/WhiteBoardMedicine Patreon members get access to mini-courses, study guides, practice questions, ad-free videos, and in-depth educational discussions designed for emergency and critical care clinicians. Disclaimer: This content is for educational purposes only and does not constitute medical advice. Clinical decisions should be made by licensed healthcare professionals using their clinical judgment, institutional protocols, and current evidence. Whiteboard Medicine assumes no responsibility for clinical outcomes.

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