Metformin
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Metformin Hypoglycaemia and lactic acidosis following accidental metformin ingestion due to product appearance confusion: case report
A 57-year-old woman developed hypoglycaemia and lactic acidosis following accidental metformin ingestion due to product appearance confusion. The woman, who had a history of end stage renal failure, presented with mild abdominal pain, nausea, back pain and 10-20 episodes of vomiting. She had no history of fever or chest pain, and there were no changes in her urinary or bowel habits. Her laboratory reports showed the following: potassium 5.1, HCO3 3.9, lactate 13.27 mmoL/L, blood glucose less than 1 mmoL, pH 6.8, ketones 7mg and anion gap 43 [not all units stated]. Her finding suggested hypoglycemia with lactic acidosis of an unknown cause [duration of treatment to reaction onset not stated]. The woman started receiving treatment with glucose, glucagon and sodium bicarbonate. Later, multiple dialysis sessions were performed to reduce the lactate level. Glucose was administered for 24 hours to maintain the blood sugar level. No hypoglycaemic attack was reported, and her blood sugar level remained between 4.4 and 7.7 mmoL. Three days later, she was made to fast for 72 hours to induce hypoglycaemia. After four days, she was discharged in good condition. She had a stable blood sugar level and no hypoglycaemic attack was observed. Metformin ingestion was suspected as her husband was diabetic and received metformin. Laboratory investigation showed an extremely high metformin in her blood. On further discussion, she admitted that she might have accidentally ingested metformin tablet [dosage not stated], that looked like paracetamol. Banki HA, et al. Hypoglycemia with severe lactic acidosis. Bahrain Medical Bulletin 42: 228-230, No. 3, Sep 2020. Available from: URL: http:// www.bahrainmedicalbulletin.com/SEPT_2020/SEPT2020_HYPOGLYCEMIA.pdf
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Reactions 5 Sep 2020 No. 1820
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