Metformin overdose
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Metformin overdose Various toxicities: 2 case reports
A report described 2 patients, of which a 35-year-old woman developed metformin intoxication secondary to overdose leading to hypoglycaemia, asphyxial syndrome, cyanosis of the extremities, multi-visceral congestion, pulmonary oedema and hepatic steatosis and a 57-year-old man developed metformin intoxication secondary to overdose leading to hypoglycaemia, asphyxiation syndrome and nail cyanosis [routes and times to reactions onsets not stated]. Case 1: The 35-year-old woman, who had diabetes, hypertension and depression, was found dead by her partner in the bathroom of her home. She had experienced symptoms of extreme tiredness since the previous day. She had been receiving treatment with metformin 1000mg and concomitant insulin detemir, paracetamol, atenolol, ramipril and mirtazapine. External examination and medicolegal autopsy showed an asphyxial syndrome associated to cyanosis of the extremities and multi-visceral congestion. Histological examination showed pulmonary oedema and hepatic steatosis. Since drug poisoning (metformin toxicity secondary to overdose leading to hypoglycaemia) was suspected, samples of femoral and cardiac blood, vitreous humour, gastric content, urine and hair were taken for toxicological tests. The samples were stored at +4°C until analysis. Head hair specimen (23cm, brown) was stored in an envelope at room temperature. Metformin was found in femoral blood, cardiac blood, vitreous humour and gastric contents at the following concentrations: 112.3 mg/L, 226.9 mg/L, 31.1 mg/L and 773.5 mg/L. Metformin concentration in hair was 28.3 ng/mg (root to 2cm), 39.4 ng/mg (2–4cm) and 44.8 ng/mg (4–6cm). Further analysis during a comprehensive toxicological screening revealed in femoral blood the presence of ethanol at a concentration of 2.4 g/L (concentration mainly linked to postmortem bio-transformation). An experienced pathologist attributed the cause of death to acute metformin intoxication. Case 2: The 57-year-old man was found dead in his bed. Based on the drugs found close to the corpse, it appeared that he was diabetic and depressed. He seemed to have been receiving treatment with metformin 1000mg and concomitant insulin glargine [Lantus], zopiclone, fluoxetine [Prozac] and pregabalin. The body examination and the post-mortem body scanner showed a marked asphyxiation syndrome with nail cyanosis. To perform toxicological tests, femoral and cardiac blood, urine and hair samples were collected. Samples of biological fluids were stored at +4°C until analysis. Head hair specimen (3cm, dark brown) was stored in an envelope at room temperature. Analysis revealed a femoral blood concentration of 64.7 mg/L, a cardiac blood concentration of 203.2 mg/L and a urine concentration of 844.9mg/L. Metformin concentration in hair was 22.5 ng/mg in the whole strand. Further analysis during a comprehensive toxicological screening revealed in femoral blood the presence of zopiclone (448 ng/mL), clobazam (324 ng/mL), amitriptyline (1.51 mg/L), pregab
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