Discussion: Metformin is an oral anti-diabetic drug used in the treatment of type 2 DM as a first-line treatment. It is absorbed from the upper part of the intestine and is excreted unmetabolized from the kidney via transporters in the proximal tubules. Elimination of metformin from the kidney takes 5 hours in those who have good renal function. But it can be accumulated in patients with acute or chronic kidney disease(4). One of the major complications of metformin is lactic acidosis despite the fact that it is rarely seen in patients with normal kidney function. Lactic acidosis is generally seen in patients with glomerular filtration rate lower than 30 mm/min. Moreover, It can be also seen in patients with metformin poisoning(5-6). Metformin-associated lactic acidosis(MALA) is a rare condition. Without diagnosis and on-time treatment, it might have detrimental consequences. The diagnosis of MALA is based on lactic acidosis following metformin exposure. Metformin levels assessment is not easy and available in most centers. And because metformin is mostly intracellular toxin, measuring levels of metformin has no value to diagnose MALA(7). The mainstay of MALA treatment is supportive. Gastrointestinal clearing with activated charcoal and treatment with sodium bicarbonate or hemodialysis are suggested. The treatment is to remove the offending agent, balance acid-base status in the normal range, and buffer to acidosis by removing lactate through dialysis. Although removal of metformin by dialysis is uncertain due to high volume (63–646 l/kg) and it is mostly intracellular toxin, dialysis has importance to treat the complications of lactic acidosis(7-8). In one of the biggest studies conducted by Peter and et al., there was no significant difference in dialyzed and undialyzed MALA patients in terms of mortality. But the patients in the dialyzed group had the higher simplified acute physiology score II (SAPSII) and need for vasopressor compared to undialyzed group. Dialyzed group were more disadvantaged compared to undialyzed group in terms of SAPS II and the need for vasopressor. Because of these two factors, there was no difference in terms of mortality between the two groups. This indicates that dialysis might be beneficial in the treatment of MALA(7).Conclusion: Continuous dialysis might be beneficial in patients with MALA not to remove the metformin but especially to treat the lactic acidosis, which might be detrimental and life-threatening.