What is the proposed duration of observation for lactic acidosis following acute overdose of metformin?
According to the cited reference, a minimum of 12 hour observation is recommended following acute overdose of metformin. This recommendation was made based on a retrospective review of NPDS data which identified 88 cases over a 14 year period. 9 cases developed Metformin Associated Lactic Acidosis (MALA) between 6-12 hours, 3 after 12 hours. (Theobald J et al. Time to development of metformin-associated lactic acidosis, Clinical Toxicology, 2019. DOI: 10.1080/15563650.2019.1686514)