Severe lactic acidosis and rhabdomyolysis following metformin and ramipril overdose.

We report the case of a 46-yr-old male who developed severe lactic acidosis, cardiorespiratory arrest, and rhabdomyolysis following an overdose of metformin and ramipril. The lactic acidosis was successfully treated with early high-volume continuous veno-venous haemofiltration. Rhabdomyolysis and lower limb compartment syndrome developed later. The patient otherwise made a good recovery. We discuss the management of severe lactic acidosis secondary to metformin overdose and the association with rhabdomyolysis.