Open AccessSuccessful Treatment of Severe Lactic Acidosis Caused by a Suicide Attempt with a Metformin Overdose
Author(s) -
Yang PorWen,
Lin KuanHung,
Lo SuHuey,
Wang LeeMing,
Lin HongDa
Publication year - 2009
Publication title -
the kaohsiung journal of medical sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.439
H-Index - 36
eISSN - 2410-8650
pISSN - 1607-551X
DOI - 10.1016/s1607-551x(09)70047-6
Subject(s) - medicine , metformin , lactic acidosis , hypoglycemia , acidosis , metabolic acidosis , hemofiltration , diabetes mellitus , renal replacement therapy , type 2 diabetes mellitus , intensive care medicine , hemodialysis , anesthesia , endocrinology
Metformin‐associated lactic acidosis is a very rare but critical condition. It is seen in patients with type 2 diabetes mellitus who take metformin and attempt suicide with a metformin overdose. Here, we report a 43‐year‐old woman with type 2 diabetes mellitus and chronic renal insufficiency who developed hypoglycemia, hypothermia, tachycardia and lactic acidosis after a suicide attempt with a metformin overdose. She was successfully treated by continuous venovenous hemofiltration, and adequate hemodynamic and ventilatory support. Although metformin does not usually cause hypoglycemia when administered as monotherapy, hypoglycemia can occur in a condition coexistent with lactic acidosis secondary to metformin overdose. Metformin intoxication should be suspected when patients present with high anion gap metabolic acidosis after attempting suicide by ingesting drugs, particularly when comorbidities such as renal failure are present. Early diagnosis and rapid correction of the metabolic acidosis using hemodialysis or hemofiltration, together with concomitant cardiovascular support, and maintenance of blood glucose and core body temperature, provide the possibility of a positive outcome.