Hyperlactataemia and clinical severity of acute metformin overdose

Internal Medicine Journal

Volumn 45, Issue 4, 2015, Pages 402-408

  McNamara, K ^a   Isbister, G K ^a,b  

^a CALVARY MATER NEWCASTLE HOSPITAL   (Australia)

^b UNIVERSITY OF NEWCASTLE   (Australia)

Author keywords

Hyperlactataemia; Lactic acidosis; Metformin; Overdose; Poisoning

Indexed keywords

ACETYLSALICYLIC ACID; ANALGESIC AGENT; ANTIHYPERTENSIVE AGENT; ATENOLOL; ATORVASTATIN; AZATHIOPRINE; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CALCIUM CHANNEL BLOCKING AGENT; CARBAMAZEPINE; DOSULEPIN; DOXEPIN; ENALAPRIL; FOSINOPRIL; GLICLAZIDE; IBUPROFEN; INSULIN ASPART; IRBESARTAN; ISOPHANE INSULIN; LACTIC ACID; METFORMIN; OMEPRAZOLE; PARACETAMOL; PREDNISONE; RAMIPRIL; SERTRALINE; THYROXINE; TRICYCLIC ANTIDEPRESSANT AGENT; UNINDEXED DRUG; VENLAFAXINE; VERAPAMIL;

ADOLESCENT; ADULT; ARTICLE; BLOOD PH; BRADYCARDIA; CASE STUDY; CLINICAL ARTICLE; CLINICAL FEATURE; COMA; DISEASE SEVERITY; DRUG INTOXICATION; DRUG OVERDOSE; FEMALE; GASTROINTESTINAL SYMPTOM; HUMAN; HYPERLACTATEMIA; HYPOGLYCEMIA; HYPOTENSION; INTENSIVE CARE UNIT; LABORATORY TEST; LACTATE BLOOD LEVEL; LACTIC ACIDOSIS; MALE; METABOLIC ACIDOSIS; MIDDLE AGED; NAUSEA AND VOMITING; NON INSULIN DEPENDENT DIABETES MELLITUS; OUTCOME ASSESSMENT; PRIORITY JOURNAL; RETROSPECTIVE STUDY; TACHYCARDIA; TOXICOLOGY; YOUNG ADULT;

EID: 84964285862     PISSN: 14440903     EISSN: 14455994     Source Type: Journal    
DOI: 10.1111/imj.12713     Document Type: Article

References (26)

1. Viollet B, Guigas B, Sanz Garcia N, Leclerc J, Foretz M, Andreelli F. Cellular and molecular mechanisms of metformin: an overview. Clin Sci (Lond) 2012; 122: 253-270.
2. Alphapharm. Diabex: Product Information Sheet [Internet]. Millers Point: Alphapharm Pty Limited; 2012 [cited 2015 Mar 5]. Available from URL: https://gp2u.com.au/static/pdf/D/DIABEX-PI.pdf
3. Protti A, Fortunato F, Monti M, Vecchio S, Gatti S, Comi GP etal. Metformin overdose, but not lactic acidosis per se, inhibits oxygen consumption in pigs. Crit Care 2012; 16: R75.
4. Juurlink DN, Roberts DM. The enigma of metformin-associated lactic acidosis. Clin Toxicol (Phila) 2014; 52: 85-87.
5. Mowry JB, Spyker DA, Cantilena LR, Bailey JE, Ford M. 2012 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 30th Annual Report. Clin Toxicol (Phila) 2013; 51: 949-1229.
6. Lam N, Sekhon G, House AA. Metformin-associated lactic acidosis following intentional overdose successfully treated with tris-hydroxymethyl aminomethane and renal replacement therapy. Case Reports Nephrol 2012; 2012: 671595.
7. Suchard JR, Grotsky TA. Fatal metformin overdose presenting with progressive hyperglycemia. West J Emerg Med 2008; 9: 160-164.
8. Timbrell S, Wilbourn G, Harper J, Liddle A. Lactic acidosis secondary to metformin overdose: a case report. J Med Case Rep 2012; 6: 230.
9. Wills BK, Bryant SM, Buckley P, Seo B. Can acute overdose of metformin lead to lactic acidosis? Am J Emerg Med 2010; 28: 857-861.
10. Forrester MB. Adult metformin ingestions reported to Texas poison control centers, 2000-2006. Hum Exp Toxicol 2008; 27: 575-583.
11. Spiller HA, Quadrani DA. Toxic effects from metformin exposure. Ann Pharmacother 2004; 38: 776-780.
12. Lalau JD, Mourlhon C, Bergeret A, Lacroix C. Consequences of metformin intoxication. Diabetes Care 1998; 21: 2036-2037.
13. Shadnia S, Barzi F, Askari A, Hassanian-Moghaddam H, Zamani N, Ebrahimian K. Metformin toxicity: a report of 204 cases from Iran. Curr Drug Saf 2013; 8: 278-281.
14. Peters N, Jay N, Barraud D, Cravoisy A, Nace L, Bollaert PE etal. Metformin-associated lactic acidosis in an intensive care unit. Crit Care 2008; 12: R149.
15. Srisawat N, Hoste EE, Kellum JA. Modern classification of acute kidney injury. Blood Purif 2010; 29: 300-307.
16. Al-Abri SA, Hayashi S, Thoren KL, Olson KR. Metformin overdose-induced hypoglycemia in the absence of other antidiabetic drugs. Clin Toxicol Informa Healthcare (52 Vanderbilt Ave., New York 10017, United States); 2013; 51: 444-447.
17. Barrueto F, Meggs WJ, Barchman MJ. Clearance of metformin by hemofiltration in overdose. J Toxicol Clin Toxicol 2002; 40: 177-180.
18. Yang P-W, Lin K-H, Lo S-H, Wang L-M, Lin H-D. Successful treatment of severe lactic acidosis caused by a suicide attempt with a metformin overdose. Kaohsiung J Med Sci 2009; 25: 93-97.
19. Levraut J, Ciebiera JP, Jambou P, Ichai C, Labib Y, Grimaud D. Effect of continuous venovenous hemofiltration with dialysis on lactate clearance in critically ill patients. Crit Care Med 1997; 25: 58-62.
20. Kajbaf F, Lalau J. The prognostic value of blood pH and lactate and metformin concentrations in severe metformin-associated lactic acidosis. BMC Pharmacol Toxicol 2013; 14: 22.
21. Duong JK, Furlong TJ, Roberts DM, Graham GG, Greenfield JR, Williams KM etal. The role of metformin in metformin-associated lactic acidosis (MALA): case series and formulation of a model of pathogenesis. Drug Saf 2013; 36; 733-746.
22. Yeung CW, Chung HY, Fong BMW, Tsai NW, Chan WM, Siu TS etal. Metformin-associated lactic acidosis in Chinese patients with type II diabetes. Pharmacology 2011; 88: 260-265.
23. Assan R, Heuclin C, Ganeval D, Bismuth C, George J, Girard JR. Metformin-induced lactic acidosis in the presence of acute renal failure. Diabetologia 1977; 13: 211-217.
24. Seidowsky A, Nseir S, Houdret N, Fourrier F. Metformin-associated lactic acidosis: a prognostic and therapeutic study. Crit Care Med 2009; 37: 2191-2196.
25. Vecchio S, Giampreti A, Petrolini VM, Lonati D, Protti A, Papa P etal. Metformin accumulation: lactic acidosis and high plasmatic metformin levels in a retrospective case series of 66 patients on chronic therapy. Clin Toxicol (Phila) 2014; 52: 129-135.
26. Isbister GK, Friberg LE, Hackett LP, Duffull SB. Pharmacokinetics of quetiapine in overdose and the effect of activated charcoal. Clin Pharmacol Ther 2007; 81: 821-827.