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Area of Science:

  • Toxicology
  • Cardiology
  • Nephrology

Background:

  • Metabolic acidosis and hyperlactatemia are recognized complications of acute metformin toxicity.
  • Acute cardiac complications, particularly cardiotoxicity, are less frequently described in metformin overdose cases.

Purpose of the Study:

  • To report a case of severe biventricular cardiac dysfunction following a large acute metformin ingestion.
  • To emphasize the potential for acute, reversible cardiotoxicity as a complication of significant metformin overdose.

Main Methods:

  • Case report of a 13-year-old female with a 150-g metformin ingestion.
  • Clinical monitoring, laboratory analysis, continuous renal replacement therapy, and echocardiography were utilized.
  • Management included correction of metabolic disturbances, vasopressors, and inotropes.

Main Results:

  • The patient developed severe metabolic acidosis, hyperlactatemia, and acute kidney injury.
  • Despite rapid correction of acidosis, she experienced biventricular cardiac dysfunction requiring intensive support.
  • Cardiac function normalized after 1 week of treatment, with resolution of vasopressor and inotrope needs.

Conclusions:

  • Acute metformin ingestion can lead to severe, reversible cardiotoxicity independent of metabolic acidosis.
  • Clinicians should consider cardiotoxicity in patients presenting with large metformin ingestions, even with timely correction of acid-base disturbances.
  • This case underscores the importance of comprehensive monitoring for end-organ damage in metformin toxicity.