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We report the case of a 63-year-old man who suffered a witnessed pulseless electrical activity cardiac arrest on presentation to the emergency department. Despite a profound post-arrest acidosis (pH 6.48) he went on to make an unexpectedly good recovery. He was treated for metformin-associated lactic acidosis (MALA) and septic shock, although the origin of the sepsis was never confirmed. We discuss the growing evidence against the existence of MALA as a lone diagnosis and the aetiology of post-cardiac arrest metabolic acidosis.

Survival following Profound Lactic Acidosis and Cardiac Arrest: Does Metformin Really Induce Lactic Acidosis?