Metformin-associated lactic acidosis (MALA) is a rare but potentially fatal complication that can occur in a patient on metformin, who had a sudden reduction in the renal function resulting in a raised serum metformin level. We describe a case of MALA who survived with prompt haemodialysis. An elderly female with diabetes on metformin presented with gastrointestinal losses, lethargy and confusion. She was in circulatory shock and despite an aggressive fluid regime, she remained acidotic with an increasing lactate level of > 15 mmol/L. After endotracheal intubation, she was referred to tertiary centre for haemodialysis. Her serum lactate level rapidly fell to a satisfactory range and a progressive recovery followed. We are highlighting this case for its rarity and to serve as a guidance on the early recognition of MALA for fellow clinicians. Despite the high mortality rate, MALA is reversible, and we urge clinicians to expedite haemodialysis as definitive treatment.

Introduction: Tuberculosis (TB) patients default their treatment during the treatment course. Therefore, this study aims to analyze the demographic characteristics of the patient who missed follow-ups and identify the reasons for missed appointments or defaulted their treatment. Methods: The records of patients diagnosed with TB follow-up at the chest clinic from January to June 2023 were reviewed based on our inclusion and exclusion criteria. Results: The retrospective descriptive analysis was conducted based on the data collected. Based on the study sample (n=33), the result shows that the majority of the defaulted patients were male in gender (n=22). Most of the missed appointments patients and defaulters are of Malay (39.4%) ethnicity and Malaysian nationality (66.7%). Most patients gave the transport issues as the reason for missed appointments followed by financial issues and feeling healthy. The majority of them missed follow-up in the first month after starting anti-TB. Conclusions In conclusion, missed appointments, treatment compliance and defaulted cases in TB treatment remain as one of the main challenges in the effort to end TB epidemics. Further in-depth research is required to propose effective measures to solve this issue and improve the national TB control program.