{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T11:06:38Z","timestamp":1779188798316,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Drug Safety"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>Metformin is a cornerstone medication and first-line therapy for type 2 diabetes mellitus (T2DM), with a well-established safety profile and widespread use over many years. Its most common adverse effects are gastrointestinal in nature. However, the drug carries a rare but serious risk of lactic acidosis. Recognized risk factors for metformin-associated lactic acidosis (MALA) include renal or hepatic impairment, excessive alcohol consumption, poorly controlled diabetes, ketosis, prolonged fasting, and conditions predisposing to hypoxia. This paper presents a case of MALA in a 75-year-old patient with T2DM and schizophrenia who lacked any typical risk factors. This case underscores the importance of maintaining a high index of suspicion for this potentially fatal complication in all patients taking metformin. Early recognition and prompt intervention are critical to improving clinical outcomes.<\/jats:p>","DOI":"10.1177\/20420986261428996","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T18:39:49Z","timestamp":1773254389000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Metformin-associated lactic acidosis in an elderly diabetic patient without classical risk factors: a case report"],"prefix":"10.1177","volume":"17","author":[{"given":"Yali","family":"Zheng","sequence":"first","affiliation":[{"name":"Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia","family":"Sun","sequence":"additional","affiliation":[{"name":"Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Affiliated Xiaoshan Hospital, Hangzhou Normal University, 728 Yucai North Road, Hangzhou 311201, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0991-4760","authenticated-orcid":false,"given":"Quanfeng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Affiliated Xiaoshan Hospital, Hangzhou Normal University, 728 Yucai North Road, Hangzhou 311201, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,7]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-023-00833-4"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/obr.12753"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-017-4318-z"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-017-4336-x"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2014.09.018"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.redox.2020.101517"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1210\/endrev\/bnaa023"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1080\/17512433.2024.2306223"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.935730"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13256-023-04219-y"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2013-201554"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2017.06.016"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tips.2020.09.001"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.2382"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-021-01339-z"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbae196"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41419-022-04752-6"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2022.09.023"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.2337\/dci23-0021"}],"container-title":["Therapeutic Advances in Drug Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20420986261428996","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20420986261428996","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20420986261428996","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T10:12:10Z","timestamp":1779185530000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20420986261428996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":19,"alternative-id":["10.1177\/20420986261428996"],"URL":"https:\/\/doi.org\/10.1177\/20420986261428996","relation":{},"ISSN":["2042-0986","2042-0994"],"issn-type":[{"value":"2042-0986","type":"print"},{"value":"2042-0994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"article-number":"20420986261428996"}}