Metformin overdose induced hypoglycemia in the absence of other antidiabetic drugs. Toxic effects from metformin exposure. She ingested around 60 tablets of 500 mg metformin as a suicide attempt after she experienced a stressful social event. During her hospitalization, she had severe lactic acidosis, hypotension corrected with fluid boluses and vasopressors, and multiple episodes of hypoglycemia (6.3 mg/dL, 38 mg/dL, and 42 mg/dL), requiring multiple 50% dextrose-water boluses.

0000166062 00000 n Pharmacol Toxicol. The patient in our case report was a young woman without previous medical history other than PCOS. 0000051789 00000 n Exercise, metformin and hypoglycemia, a neglected entity. 1997;26:523–37.Madiraju AK, Erion DM, Rahimi Y, et al. She was on metformin for weight reduction (her body mass index was 28), as she was found to have polycystic ovarian syndrome (PCOS). J Med Case Rep. 2012;6:18.Al-Abri SA, Hayashi S, Thoren KL, Olson KR. During the hospital stay, her blood sugar was monitored frequently (Table On day 3, she was transferred to the ward with normal mental status and vital signs. San Francisco, CA, USA San Francisco Division, California Poison Control System, University of California, The metformin concentration was 25.4 mg/L (treatment dose <15 mg/L). 0000004687 00000 n 2017 Jan 30;107(2):110-111. doi: 10.7196/SAMJ.2017.v107i2.10971.Emerg Med J. She was tolerating oral intake and did not develop any more hypoglycemic attacks. 0000005501 00000 n

In the emergency department, 4 hours after of the event, she was fatigued but vitally stable. 0000015926 00000 n 2011;89:416–21.Tzvetkov MV, Vormfelde SV, Balen D, Meinekei I, Schmidt T, Sehrt D. The effects of genetic polymorphisms in the organic cation transporters OCT1, OCT2, and OCT3 on the renal clearance of metformin. SA reviewed the literature and wrote the draft manuscript. 0000146946 00000 n

0000167116 00000 n 0000008332 00000 n In the present paper we report on the treatment and outcome of a 70 year old man after ingestion of 63 g of metformin. You can also search for this author in The psychiatrist was consulted for further assessment and treatment. General issues relating to hypoglycemia, the therapeutic use of biguanides, and the general clinical management of drug intoxication are presented separately. Nature. 2004;38:776–80.Yang PW, Lin KH, Lo SH, Wang LM, Lin HD.

Hypoglycemia is a rarely reported complication of metformin ingestion in either therapeutic or overdose situations with an incidence ranging from 0.6 to 12.2% 9, 15-18. Suicide with metformin is rare. 12 Evidence for a causal relation between hypoglycemia and cardiovascular disease or death is limited, because patients at risk for hypoglycemia also have factors that increase their risk for those … 1998). 0000011935 00000 n San Francisco, CA, USA Department of Laboratory Medicine, University of California,

In addition, the norepinephrine infusion was discontinued during CRRT with normal hemodynamic status.Metformin absorption, liver uptake, and kidney elimination are affected by organic cation transporters (OCTs), with variation in liver uptake and clinical effects due to the differences in their expression level in the liver [Hypoglycemia can be induced by metformin toxicity in the absence of other co-ingestions, and close monitoring of blood glucose is crucial. 2015 Sep;49(9):851-2. doi: 10.1177/0004867415584642. © 2020 BioMed Central Ltd unless otherwise stated. Survival following a metformin overdose of 63 g: a case report.

0000008496 00000 n Our patient was responding very well to the CRRT, her lactic acidosis was resolving with time and her renal function remained intact during her hospital stay. On examination, she was alert and well-nourished but generally fatigued, with no pallor, jaundice, or cyanosis. 2002;40:108–10.Omari A, Yue DK, Twigg SM. Intake of 35 g of metformin has been shown to be lethal (Teale et al . On the fifth day of hospitalization, our patient was discharged home with a good health status. In addition, hypoglycemia following metformin overdose was reported in a 43-year-old woman, and the authors considered that the hypoglycemia was secondary to a net result of metformin toxicity and decreased oral in-take with renal impairment, however, co-ingestions were not excluded [12]. 0000009966 00000 n 1988 Dec;22(4):448-53. doi: 10.3109/00048678809161355.Indian J Psychol Med. When abnormal glucose levels occur with metformin ex-posures, hypoglycemia is much more commonly seen than hy- perglycemia; hypoglycemia is usually ascribed to concurrent anti-diabetic medications such as the sulfonylureas [8]. Under certain conditions, too much metformin can cause lactic acidosis. xref

Poult Sci. Endocrinol Metab Clin N Am. Metformin toxicity is well known to cause lactic acidosis. 0000015227 00000 n Therefore, we performed a toxicologic analysis. 0000007469 00000 n This site needs JavaScript to work properly. Clin Toxicol (Phila).