Related Experiment Videos
Acute intoxication by phenformine hyperlactatemia reversible with extra-renal purification
Veterinary and Human Toxicology
|January 1, 1979
Summary
This case study details a severe metformin overdose complicated by barbiturate coma and hyperlactatemia. Hemodialysis successfully normalized lactate levels, revealing liver cell damage.
Area of Science:
- Toxicology
- Pharmacology
- Internal Medicine
Background:
- Metformin is a common first-line treatment for type 2 diabetes.
- Acute overdose of metformin can lead to severe metabolic disturbances.
- Phenobarbital and belladonna extract are potent central nervous system depressants.
Observation:
- A 53-year-old diabetic patient presented with acute intoxication after ingesting 25.5g metformin, 2.5g phenobarbital, and 12.5g belladonna extract.
- The patient developed barbiturate-induced coma and severe hyperlactatemia (21 mmol/L).
Findings:
- Hemodialysis using a polyacrylonitrile membrane for 24 hours effectively normalized lactatemia within 36 hours.
- Biological monitoring included barbitemia, lactacidemia, and metforminemia.
- Hepatic biopsy revealed steatosis and mitochondrial alterations consistent with pathological hyperlactatemia.
Implications:
- This case highlights the critical interplay between metformin toxicity, barbiturate effects, and metabolic derangements.
- Effective management of severe metformin overdose with barbiturate coma requires intensive supportive care, including hemodialysis.
- The observed liver pathology underscores the cellular mechanisms underlying metformin-induced hyperlactatemia.