Taub ES, et al. - Clinical characteristics and risk factors for metabolic acidosis with hyperlactatemia in Emergency Department (ED) patients with acute metformin overdose were described via performing a secondary analysis of data from a retrospective observational cohort of adult ED patients presenting with acute drug overdose at two tertiary care hospitals over 5 years. Screening of 3739 acute overdoses was done; eligibility criteria were met by 2872, self-reported metformin overdose was reported in 56 (57% female, mean age 55.8). They identified initial hyperlactatemia commonly but metformin-associated lactic acidosis (MALA) unusually among ED patients with acute metformin overdose. A novel independent risk factor for MALA occurrence was acetaminophen co-exposure that merits further investigation.