Electrolyte Blood Press.  2019 Jun;17(1):16-20. 10.5049/EBP.2019.17.1.16.

Transient Blindness in a Patient with Severe Metformin-Associated Lactic Acidosis (MALA)

  • 1Division of Nephrology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea. jeonjwan@cnuh.co.kr
  • 2Department of Internal Medicine, Busan Bumin Hospital, Busan, Korea.
  • 3Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.


A 68-year-old man presented at the emergency room with sudden blindness. The day before, he had eaten sashimi and eel and drank alcohol for dinner. He experienced nausea, vomiting, and dizziness afterward. His medical history included hypertension and diabetes, and the latter was treated with metformin. Initial laboratory tests revealed severe metabolic acidosis (lactic acidosis). Massive hydration and intravenous sodium bicarbonate replacement therapies were initiated, but severe metabolic acidosis (lactic acidosis) did not resolve, in turn, leading to hemodialysis, which decreased metabolic acidosis. The patient's blindness improved, and his vision gradually recovered. As it is not easy to distinguish between blindness related to metformin-associated lactic acidosis (MALA) and blindness related to other causes, rapid correction of metabolic acidosis through hemodialysis might be helpful in differentiating this from of blindness from blindness related to other causes.


Transient blindness; Metformin-associated lactic acidosis (MALA); Metabolic acidosis; Hemodialysis

MeSH Terms

Acidosis, Lactic*
Emergency Service, Hospital
Renal Dialysis
Sodium Bicarbonate
Sodium Bicarbonate


  • Fig. 1 Fundoscopic examination. (A) Right eye, a dot-like retinal hemorrhage was observed (red circle), (B) Left eye, a dot-like retinal hemorrhage (red circle) and hard exudate (arrow) were observed, showing severe non-proliferative diabetic retinopathy.

  • Fig. 2 Changes in patient vital signs. *sBP, systolic blood pressure; dBP, diastolic blood pressure; HR, heart rate; BT, body temperature. *★: vision recovery (3 h 30 min after admission).

  • Fig. 3 Changes in metabolic acidosis. *★: vision recovery (3 h 30 min after admission).


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