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Lactic acidosis secondary to metformin overdose: a case report
INTRODUCTION: Metformin is a commonly used treatment modality in type 2 diabetes mellitus, with a well documented side effect of lactic acidosis. In the intensive care setting lactate and pH levels are regularly used as a useful predictor of poor prognosis. In this article we highlight how high lact...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3469375/ https://www.ncbi.nlm.nih.gov/pubmed/22857657 http://dx.doi.org/10.1186/1752-1947-6-230 |
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author | Timbrell, Simon Wilbourn, Gary Harper, James Liddle, Alan |
author_facet | Timbrell, Simon Wilbourn, Gary Harper, James Liddle, Alan |
author_sort | Timbrell, Simon |
collection | PubMed |
description | INTRODUCTION: Metformin is a commonly used treatment modality in type 2 diabetes mellitus, with a well documented side effect of lactic acidosis. In the intensive care setting lactate and pH levels are regularly used as a useful predictor of poor prognosis. In this article we highlight how high lactate levels are not an accurate predictor of mortality in deliberate metformin overdose. CASE PRESENTATION: We present the case of a 70-year-old Caucasian man who took a deliberate metformin overdose of unknown quantity. He had a profound lactic acidosis at presentation with a pH of 6.93 and a lactate level of more than 20mmol/L. These figures would normally correspond with a mortality of more than 80%; however, with appropriate management this patient’s condition improved. CONCLUSION: We provide evidence that the decision to treat severe lactic acidosis in deliberate metformin overdose should not be based on arterial lactate and pH levels, as would be the case in other overdoses. We also demonstrate that appropriate treatment with hemodiafiltration and 8.4% sodium bicarbonate, even in patients with a very high lactate and low pH, can be successful. |
format | Online Article Text |
id | pubmed-3469375 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-34693752012-10-18 Lactic acidosis secondary to metformin overdose: a case report Timbrell, Simon Wilbourn, Gary Harper, James Liddle, Alan J Med Case Rep Case Report INTRODUCTION: Metformin is a commonly used treatment modality in type 2 diabetes mellitus, with a well documented side effect of lactic acidosis. In the intensive care setting lactate and pH levels are regularly used as a useful predictor of poor prognosis. In this article we highlight how high lactate levels are not an accurate predictor of mortality in deliberate metformin overdose. CASE PRESENTATION: We present the case of a 70-year-old Caucasian man who took a deliberate metformin overdose of unknown quantity. He had a profound lactic acidosis at presentation with a pH of 6.93 and a lactate level of more than 20mmol/L. These figures would normally correspond with a mortality of more than 80%; however, with appropriate management this patient’s condition improved. CONCLUSION: We provide evidence that the decision to treat severe lactic acidosis in deliberate metformin overdose should not be based on arterial lactate and pH levels, as would be the case in other overdoses. We also demonstrate that appropriate treatment with hemodiafiltration and 8.4% sodium bicarbonate, even in patients with a very high lactate and low pH, can be successful. BioMed Central 2012-08-02 /pmc/articles/PMC3469375/ /pubmed/22857657 http://dx.doi.org/10.1186/1752-1947-6-230 Text en Copyright ©2012 Timbrell et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Timbrell, Simon Wilbourn, Gary Harper, James Liddle, Alan Lactic acidosis secondary to metformin overdose: a case report |
title | Lactic acidosis secondary to metformin overdose: a case report |
title_full | Lactic acidosis secondary to metformin overdose: a case report |
title_fullStr | Lactic acidosis secondary to metformin overdose: a case report |
title_full_unstemmed | Lactic acidosis secondary to metformin overdose: a case report |
title_short | Lactic acidosis secondary to metformin overdose: a case report |
title_sort | lactic acidosis secondary to metformin overdose: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3469375/ https://www.ncbi.nlm.nih.gov/pubmed/22857657 http://dx.doi.org/10.1186/1752-1947-6-230 |
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