Acute intoxication by phenformine hyperlactatemia reversible with extra-renal purification

The authors report the observation of an acute intoxication with 25.5 g of metaformin, 2.5 g of phenobarbital and 12.5 g of belladonna extract in a 53 year-old diabetic patient having been treated with metformin for 5 years. The evolution was dominated by the association of a barbituric coma with an hyperlactatemia which reached 21 mmol/l during the 18th hour and normalized at the 36th hour thanks to an hemodialysis on polyacrilonitrile membrane, which was carried out for 24 hours. The biological evolution was determined in considering the barbitemia, lactacidemia and metforminemia rates. An hepatic biopsy made during the decrease of the hyperlactatemia enabled to consider histological lesions of steatosis and ultrastructural lesions of mitochondrial alteration, already described in the course of pathological hyperlactatemia.