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Fatal metformin overdose presenting with progressive hyperglycemia
Jeffrey R Suchard1, Thomas A Grotsky
1Department of Emergency Medicine, University of California, Irvine School of Medicine.
The Western Journal of Emergency Medicine
|June 30, 2009
Summary
A severe metformin overdose caused acute renal insufficiency, lactic acidosis, and record-high hyperglycemia in a non-diabetic patient. Despite treatment, the patient experienced cardiac arrests and expired.
Area of Science:
- Toxicology
- Endocrinology
- Nephrology
Background:
- Metformin is a common medication for type 2 diabetes.
- Intentional overdoses of metformin can lead to severe metabolic disturbances.
- Acute toxicity can occur even in individuals without pre-existing diabetes.
Purpose of the Study:
- To report a rare case of metformin toxicity in a non-diabetic individual.
- To highlight the extreme hyperglycemia and acute renal insufficiency associated with a massive metformin overdose.
- To discuss the clinical presentation and management of severe metformin poisoning.
Main Methods:
- Case report of a 29-year-old male patient.
- Inclusion of clinical presentation, laboratory values, and treatment interventions.
- Review of peak serum glucose and lactate levels.
Main Results:
- The patient ingested over 60 grams of metformin.
- Presented with acute renal insufficiency, severe lactic acidosis, and peak serum glucose of 707 mg/dL.
- Despite sodium bicarbonate and hemodialysis, the patient suffered cardiac arrests and expired.
Conclusions:
- Massive metformin overdose can cause life-threatening hyperglycemia and acidosis, even in non-diabetics.
- Prompt and aggressive management, including hemodialysis, is crucial.
- This case highlights the upper limits of metformin toxicity and its severe consequences.
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