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10.1016/j.arr.2023.101936 46 WanX.GargN

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An accumulation of lactate to dangerous levels ( lactic acidosis ) can occur when metformin is taken by patients with other conditions resulting metabolic acidosis (liver disease, heart failure, sepsis, alcohol abuse), or kidney disease (as indicated by elevated creatinine levels) because metformin is eliminated by renal excretion) (He & Wondisford, 2015