Cargando…

Refractory vasodilatory shock secondary to metformin overdose supported with VA ECMO()

Metformin overdose may result in vasodilatory shock, lactic acidosis and death. Hemodialysis is an effective means of extracorporeal elimination, but may be insufficient in the shock setting. We present a case of a 39 yo male who presented with hypotension, coma, hypoglycemia, and lactate of 6.5 mmo...

Descripción completa

Detalles Bibliográficos
Autores principales: Ives Tallman, Crystal, Zhang, Yu, Black, Nicholas, Lynch, Kara, Fayed, Mohamed, Armenian, Patil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8718576/
https://www.ncbi.nlm.nih.gov/pubmed/35004183
http://dx.doi.org/10.1016/j.toxrep.2021.12.010
_version_ 1784624759683678208
author Ives Tallman, Crystal
Zhang, Yu
Black, Nicholas
Lynch, Kara
Fayed, Mohamed
Armenian, Patil
author_facet Ives Tallman, Crystal
Zhang, Yu
Black, Nicholas
Lynch, Kara
Fayed, Mohamed
Armenian, Patil
author_sort Ives Tallman, Crystal
collection PubMed
description Metformin overdose may result in vasodilatory shock, lactic acidosis and death. Hemodialysis is an effective means of extracorporeal elimination, but may be insufficient in the shock setting. We present a case of a 39 yo male who presented with hypotension, coma, hypoglycemia, and lactate of 6.5 mmol/L after ingesting an unknown medication. Metformin overdose was suspected, and he was started on hemodialysis. He developed profound vasoplegia refractory to high doses of norepinephrine, vasopressin, epinephrine and phenylephrine. Venoarterial extracorporeal membrane oxygenation (VA ECMO) was initiated and he had full recovery. Serum analysis with high resolution liquid chromatography mass spectrometry revealed a metformin level of 678 μg/mL and trazodone level of 2.1 μg/mL. This case is one of only a handful of reported cases of metformin overdose requiring ECMO support, and we report the highest serum metformin levels in the literature to date. We recommend early aggressive hemodialysis and vasopressor support in all suspected cases of metformin toxicity as well as VA ECMO if refractory to these therapies. OBJECTIVE: We present a case of vasodilatory shock secondary to metformin overdose requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) support. This case is one of only a handful of reported cases of metformin overdose requiring ECMO support, and we report the highest serum metformin levels in the literature to date. DATA SOURCES: University of San Francisco, Fresno. STUDY DESIGN: Case report. DATA EXTRACTION: Clinical records and high resolution liquid chromatography mass spectroscopy analysis. DATA SYNTHESIS: None. CONCLUSIONS: Venoarterial ECMO provided an effective means of hemodynamic support for a patient with severe metformin toxicity.
format Online
Article
Text
id pubmed-8718576
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-87185762022-01-06 Refractory vasodilatory shock secondary to metformin overdose supported with VA ECMO() Ives Tallman, Crystal Zhang, Yu Black, Nicholas Lynch, Kara Fayed, Mohamed Armenian, Patil Toxicol Rep Case Report Metformin overdose may result in vasodilatory shock, lactic acidosis and death. Hemodialysis is an effective means of extracorporeal elimination, but may be insufficient in the shock setting. We present a case of a 39 yo male who presented with hypotension, coma, hypoglycemia, and lactate of 6.5 mmol/L after ingesting an unknown medication. Metformin overdose was suspected, and he was started on hemodialysis. He developed profound vasoplegia refractory to high doses of norepinephrine, vasopressin, epinephrine and phenylephrine. Venoarterial extracorporeal membrane oxygenation (VA ECMO) was initiated and he had full recovery. Serum analysis with high resolution liquid chromatography mass spectrometry revealed a metformin level of 678 μg/mL and trazodone level of 2.1 μg/mL. This case is one of only a handful of reported cases of metformin overdose requiring ECMO support, and we report the highest serum metformin levels in the literature to date. We recommend early aggressive hemodialysis and vasopressor support in all suspected cases of metformin toxicity as well as VA ECMO if refractory to these therapies. OBJECTIVE: We present a case of vasodilatory shock secondary to metformin overdose requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) support. This case is one of only a handful of reported cases of metformin overdose requiring ECMO support, and we report the highest serum metformin levels in the literature to date. DATA SOURCES: University of San Francisco, Fresno. STUDY DESIGN: Case report. DATA EXTRACTION: Clinical records and high resolution liquid chromatography mass spectroscopy analysis. DATA SYNTHESIS: None. CONCLUSIONS: Venoarterial ECMO provided an effective means of hemodynamic support for a patient with severe metformin toxicity. Elsevier 2021-12-21 /pmc/articles/PMC8718576/ /pubmed/35004183 http://dx.doi.org/10.1016/j.toxrep.2021.12.010 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Ives Tallman, Crystal
Zhang, Yu
Black, Nicholas
Lynch, Kara
Fayed, Mohamed
Armenian, Patil
Refractory vasodilatory shock secondary to metformin overdose supported with VA ECMO()
title Refractory vasodilatory shock secondary to metformin overdose supported with VA ECMO()
title_full Refractory vasodilatory shock secondary to metformin overdose supported with VA ECMO()
title_fullStr Refractory vasodilatory shock secondary to metformin overdose supported with VA ECMO()
title_full_unstemmed Refractory vasodilatory shock secondary to metformin overdose supported with VA ECMO()
title_short Refractory vasodilatory shock secondary to metformin overdose supported with VA ECMO()
title_sort refractory vasodilatory shock secondary to metformin overdose supported with va ecmo()
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8718576/
https://www.ncbi.nlm.nih.gov/pubmed/35004183
http://dx.doi.org/10.1016/j.toxrep.2021.12.010
work_keys_str_mv AT ivestallmancrystal refractoryvasodilatoryshocksecondarytometforminoverdosesupportedwithvaecmo
AT zhangyu refractoryvasodilatoryshocksecondarytometforminoverdosesupportedwithvaecmo
AT blacknicholas refractoryvasodilatoryshocksecondarytometforminoverdosesupportedwithvaecmo
AT lynchkara refractoryvasodilatoryshocksecondarytometforminoverdosesupportedwithvaecmo
AT fayedmohamed refractoryvasodilatoryshocksecondarytometforminoverdosesupportedwithvaecmo
AT armenianpatil refractoryvasodilatoryshocksecondarytometforminoverdosesupportedwithvaecmo