Metformin Overdose With a Resultant Serum pH of 6.59: Survival Without Sequalae

Journal of Emergency Medicine

Volumn 39, Issue 1, 2010, Pages

  Dell'Aglio, Damon M ^a   Perino, Louis J ^a   Todino, Joel D ^b   Algren, D Adam ^a   Morgan, Brent W ^a  

^a EMORY UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b Floyd Medical Center   (United States)

Author keywords

hemodialysis; lactic acidosis; metabolic acidosis; metformin; overdose

Indexed keywords

BICARBONATE; DOPAMINE; HYPERTENSIVE AGENT; LACTIC ACID; METFORMIN; NORADRENALIN; VASOPRESSIN; ANTIDIABETIC AGENT;

ADULT; ARTICLE; ARTIFICIAL VENTILATION; BLOOD PH; CASE REPORT; DRUG OVERDOSE; FEMALE; HEMODIALYSIS; HUMAN; HYPOTENSION; HYPOTHERMIA; LACTATE BLOOD LEVEL; LACTIC ACIDOSIS; PRIORITY JOURNAL; BLOOD; CHEMICALLY INDUCED; INTOXICATION;

ACIDOSIS, LACTIC; ADULT; FEMALE; HUMANS; HYPOGLYCEMIC AGENTS; HYPOTENSION; METFORMIN; OVERDOSE; POISONING; SODIUM BICARBONATE; DRUG OVERDOSE;

EID: 77953620492     PISSN: 07364679     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.jemermed.2007.09.034     Document Type: Article

References (24)

1. Barrueto F., Meggs W.J., and Barchman M.J. Clearance of metformin by hemofiltration in overdose. J Toxicol Clin Toxicol 40 (2002) 177-180
2. Chin-Tung G., Yung-Chang C., Ji-Tseng F., and Chiu-Ching H. High anion gap metabolic acidosis in suicide: don't forget metformin intoxication-two patients' experience. Ren Fail 24 (2002) 671-675
3. Teale K.F.H., Devine A., Stewart H., and Harper N.J.H. The management of metformin overdose. Anaesthesia 53 (1998) 698-701
4. von-Mach M.A., Sauser O., and Weilemann L.S. Experience of a poison center with metformin-associated lactic acidosis. Exp Clin Endocrinol Diabetes 112 (2004) 187-190
5. Sirtori C.R., and Pasik C. Re-evaluation of biguanide, metformin: mechanism of action and tolerability. Pharmacol Res 30 (1994) 187-228
6. Ahmad S., and Beckett M. Recovery from ph 6.38: lactic acidosis complicated by hypothermia. Emerg Med J 19 (2002) 169-171
7. Spiller H.A., and Quadrani D.A. Toxic effects from metformin exposure. Ann Pharmacother 8 (2004) 776-780
8. Spiller H.A., Weber J.A., Winter M.L., Klein-Schwartz W., and Hofman M. Multicenter case series of pediatric metformin overdose. Ann Pharmacother 34 (2000) 1385-1387
9. Bailey C.J., and Turner R.C. Metformin. N Engl J Med 334 (1996) 574-579
10. th edn. (2006), McGraw-Hill Companies Inc., New York 749-763
11. Kruse J.A. Metformin-associated lactic acidosis. J Emerg Med 20 (2001) 267-272
12. Lalau J.D., and Race J.M. Lactic acidosis in metformin-treated patients: prognostic value of arterial lactate levels and plasma metformin concentrations. Drug Saf 20 (1999) 377-384
13. Levraut J., and Grimaud D. Treatment of metabolic acidosis. Curr Opin Crit Care 9 (2003) 260-265
14. Lalau J.D., and Race J.M. Lactic acidosis in metformin therapy: searching for a link with metformin in reports of 'metformin-associated lactic acidosis'. Diabetes Obes Metab 3 (2001) 195-201
15. Bismuth C., Gaultier M., Conso F., Assan R., and Heuclin C. Acidose lactique induite par l'ingestion excessive de metformine. Eur J Toxicol 9 (1976) 55-57
16. Nisse P., Mathieu-Nolf M., Deveaux M., Forceiville X., and Combes A. A fatal case of metformin poisoning. J Toxicol Clin Toxicol 41 (2003) 1037-1038
17. Spiller H.A. Management of anti-diabetic medications in overdose. Drug Saf 19 (1998) 411-424
18. Gjedde S., Christiansen A., Pedersen S.B., and Rungby J. Survival following a metformin overdose of 63g: a case report. Pharmacol Toxicol 93 (2003) 98-99
19. Lacher M., Hermanns-Clause M., Haeffner K., Brandis M., and Pohl M. Severe metformin intoxication with lactic acidosis in an adolescent. Eur J Pediatr 164 (2005) 362-365
20. Lalau J.D., Mourhlhon C., Bergeret A., and Lacroix C. Consequences of metformin intoxication. Diabetes Care 21 (1998) 2036-2037
21. Doorenbos C.J., Bosma R.J., and Lamberts P.J.N. Use of urea containing dialysate to avoid disequilibrium syndrome, enabling intensive dialysis treatment of a diabetic patient with renal failure and severe metformin induced lactic acidosis. Nephrol Dial Transplant 16 (2001) 1303-1304
22. Ganetsky M., Donner B., Kent K.J., and Bird S.B. Should we dialyze metformin induced lactic acidosis?. A case report with urine metformin concentrations. J Toxicol Clin Toxicol 44 (2006) 661-662
23. Sambol N.C., Chiang J., O'Conner M., et al. Pharmacokinetics and pharmacodynamics of metformin in healthy subjects and patients with non-insulin-dependent diabetes mellitus. J Clin Pharmacol 36 (1996) 1012-1021
24. Dell'Aglio D.M., Perino L.J., Kazzi Z.N., Morgan B.W., Schwartz M.D., and Geller R.J. Mortality in acute metformin overdose is predicted by serum pH, lactate, and metformin concentration. J Toxicol Clin Toxicol 44 (2006) 712