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A case of fatal intoxication from metformin
Veniero Gambaro1, Lucia Dell'acqua, Fiorenza Farè
1Institute of Pharmaceutical and Toxicological Chemistry, University of Milan, Viale Abruzzi 42, 20131 Milano, Italy. veniero.gambaro@unimi.it
Journal of Forensic Sciences
|May 26, 2007
Summary
A fatal case of metformin intoxication is detailed, where acute renal failure led to severe lactic acidosis due to drug accumulation. This highlights the critical importance of kidney function in metformin pharmacokinetics.
Area of Science:
- Toxicology
- Clinical Chemistry
- Pharmacology
Background:
- Metformin is a common oral hypoglycemic agent for type II diabetes.
- Acute renal failure can impair metformin clearance, increasing accumulation risk.
- Metformin accumulation can lead to severe lactic acidosis, a life-threatening condition.
Observation:
- A case of fatal metformin intoxication is presented in a 58-year-old obese female with type II diabetes.
- The patient developed severe lactic acidosis secondary to metformin accumulation, precipitated by acute renal failure.
- Postmortem blood analysis revealed a metformin concentration of 77.3 microg/mL.
Findings:
- High-performance liquid chromatography (HPLC) was used for metformin quantification in postmortem blood.
- The analytical method involved acetonitrile deproteinization, dichloromethane wash, and RP-8 column separation.
- Liquid chromatography coupled with atmospheric pressure chemical ionization tandem mass spectrometry (LC/APCI/MS/MS) confirmed the qualitative result.
Implications:
- This case underscores the critical role of renal function in preventing metformin-induced lactic acidosis.
- Accurate postmortem toxicological analysis is crucial for determining the cause of death in suspected drug intoxication.
- Understanding metformin pharmacokinetics and potential toxic levels is vital for patient safety and clinical management.
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