ABSTRACT
Glucose lowering biguanides were discovered in the 1920s. Due to the association of phenformin and buformin with lactic acidosis, they were withdrawn from the market, but metformin was continued to be used as there was lesser incidence of latic acidosis when compared to Phenformin and buformin , and in fact, it is considered as the first-line drug of choice for type 2 diabetes mellitus (DM) especially in those with normal renal function. It is contraindicated in patients suffering from chronic kidney disease, liver disease, renal failure as there is increase chance of lactic acidosis. It can also rarely induce encephalopathy through lactic acidosis, hypoglycemia, renal impairment, and liver failure. There are only few case reports of metformin encephalopathy in end-stage renal disease (ESRD). we report one such case in a patient with end-stage renal failure undergoing maintenance hemodialysis.