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Fatal metformin overdose: case report and postmortem biochemistry contribution
Alessandro Bonsignore1, Fulvia Pozzi, Giulio Fraternali Orcioni
1Department of Legal Medicine, University of Genova, Genoa, Italy.
International Journal of Legal Medicine
|November 9, 2013
Summary
Metformin overdose can cause fatal lactic acidosis, especially in patients with impaired kidney function. This case highlights the importance of toxicology in understanding metformin-related deaths.
Area of Science:
- Pharmacology
- Toxicology
- Nephrology
Background:
- Metformin is a common oral antihyperglycemic agent for type 2 diabetes.
- Lactic acidosis is a rare but serious complication of metformin, particularly in overdose.
- Impaired renal function can lead to increased metformin plasma concentrations.
Observation:
- An autopsy case of a 70-year-old woman with diabetes and renal impairment treated with metformin.
- High metformin concentrations (42-47.3 µg/ml) were detected in blood samples.
- Severe lactic acidosis (29.10 mmol/l) and ketoacidosis (10,500 µmol/l) were diagnosed.
Findings:
- Death was attributed to metformin-induced lactic acidosis.
- Elevated metformin levels were linked to the patient's severely impaired renal function.
- The case underscores the role of metformin intoxication in fatalities.
Implications:
- Highlights the critical need for renal function monitoring in metformin-treated patients.
- Emphasizes the importance of comprehensive toxicology and postmortem biochemistry in investigating deaths.
- Informs clinical practice regarding metformin use in patients with kidney disease.
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