Metformin overdose
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Fatal lactic acidosis: case report A 55-year-old man developed lactic acidosis after administering an overdose of metformin in a suicide attempt. He subsequently died. The man presented 3.5 hours after ingesting fifty to sixty metformin 850mg tablets; he was transferred to another hospital. He reported abdominal pain, nausea and somnolence on admission. He had a 3-year history of type 2 diabetes mellitus and had been receiving metformin [details not stated], glipizide and rosiglitazone. He was lethargic on examination with a BP of 90/50mm Hg and a HR of 110 beats/min. An isotonic infusion, and charcoal were initiated. Investigations revealed the following values: haemoglobin 12.8 g/dL, urea 23 mg/dL, creatinine 1.8 mg/dL, blood glucose 352 mg/dL, LDH 441 IU/L, lactate >181 mg/dL, pH 7.29, pO2 44mm Hg, pCO2 39mm Hg, oxygen saturation 74% and HCO3 18 mEq/L. An ECG showed sinus rhythm. Bicarbonate was initiated, and the man was moved to the ICU. He became hypotensive and experienced respiratory arrest; intubation was performed. Arterial blood gas analysis revealed the following values: pH 6.8, pO2 85mm Hg, oxygen saturation 86%, pCO2 49mm Hg and HCO3 7 mEq/L. Haemofiltration was carried out, yet he subsequently experienced heart arrest. Despite receiving CPR, he died. Kavalci C, et al. Fatal lactic acidosis due to metformine. Internet Journal of 803021876 Internal Medicine 8: No. 1, 2009 - Turkey
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Reactions 3 Jul 2010 No. 1308
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