ABSTRACT
Severe lactic acidosis is a rare but life threatening complication of metformin, particularly in patients with renal failure. The mortality rate of metformin induced lactic acidosis is about 50%. Metformin is usually prescribed in type 2 diabetes and is a recognized cause of lactic acidosis in predisposed diabetic patients. We present a case of anorexia nervosa [AN] admitted with severe lactic acidosis and acute renal failure induced by six months of self medication with metformin attempting further weight reduction. The patient was volume resuscitated and started on bicarbonate infusion. She underwent immediate hemodialysis with rapid and prompt recovery. The relation between metformin induced lactic acidosis and anorexia nervosa is not known before. Reversible tubular dysfunction that may mimic Fanconi syndrome has been documented in one report. AN can be considered an additional risk factor for metformin induced lactic acidosis