Clinical management of metformin overdose: A case report

Clinical management of metformin overdose: A case report

Metformin is first-line therapy in diabetes mellitus treatment. Metformin intoxication may cause lactic acidosis. A 29-year-old woman presented to our emergency department with loss of consciousness. Arterial blood gas revealed severely increased anion gap lactic acidosis. Continuous venovenous hemofiltration was performed for 39 h. After extracorporeal treatment, the acidosis resolved and the patient became conscious. There is no specific treatment for metformin intoxication; current treatment is supportive only. Our aim is to highlight the diagnosis, chromatographic measurement of the drug blood level, and management of metformin overdose.

___

  • Bruijstens LA, van Luin M, Buscher-Jungerhans PM, Bosch FH. Reality of severe metformin-induced lactic acidosis in the ab sence of chronic renal impairment. Neth J Med 2008;66:185-90. Cullen E, Liao J, Lukacsko P, Niecestro R, Friedhoff L. Pharmacokinetics and döşe proportionality of extended-release met formin following administration of 1000, 1500, 2000 and 2500 mg in healthy volunteers. Biopharm Drug Dispos 2004;25:261- 3. Davenport A, Will EJ, Davidson AM. Improved cardiovascular stability during continuous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure. Crit Care Med 1993;21:328-38. Gan SC, Barr J, Arieff AI, Pearl RG. Biguanide-associated lactic acidosis. Case report and review of the literature. Arch Intern Med 1992;152:2333-6. Lalau JD, Westeel PF, Debussche X, et al. Bicarbonate haemodialysis: an adequate treatment for lactic acidosis in diabetics tre ated by metformin. Intensive Care Med 1987;13:383-7. Luft D, Deichsel G, Schmülling RM, Stein W, Eggstein M. Definition of clinically relevant lactic acidosis in patients with inter nal diseases. Am J Clin Pathol 1983;80:484-9. Luft D, Schmülling RM, Eggstein M. Lactic acidosis in biguanide-treated diabetics: a review of 330 cases. Diabetologia 1978;14:75-87. Misbin RI. Phenformin-associated lactic acidosis: pathogenesis and treatment. Ann Intern Med 1977;87:591-5. Moore KA, Levine B, Titus JM, Fowler DR. Analysis of metformin in antemortem serum and postmortem specimens by a novel HPLC method and application to an intoxication case. J Anal Toxicol 2003;27:592-4. Perrone J, Phillips C, Gaieski D. Occult metformin toxicity in three patients with profound lactic acidosis. J Emerg Med 2011;40:271-5. Soyoral YU, Begenik H, Emre H, Aytemiz E, Ozturk M, Erkoc R. Dialysis therapy for lactic acidosis caused by metformin in toxication: presentation of two cases. Hum Exp Toxicol 2011 Dec;30:1995-7. Spiller HA. Management of antidiabetic medications in overdose. Drug Saf 1998;19:411-24. Stang M, Wysowski DK, Butler-Jones D. Incidence of lactic acidosis in metformin users. Diabetes Care 1999;22:925-7. Von Mach MA, Sauer O, Sacha Weilemann L. Experiences of a poison center with metformin-associated lactic acidosis. Exp Clin Endocrinol Diabetes 2004;112:187-90. Yang PW, Lin KH, Lo SH, Wang LM, Lin HD. Successful treatment of severe lactic acidosis caused by a suicide attempt with a metformin overdose. Kaohsiung J Med Sci 2009;25:93-7.