Metformin overdose can cause severe hypoglycemia in the absence of other antidiabetic drugs. Potential mechanisms of metformin-induced hypoglycemia include decreased hepatic glucose production, decreased glucose absorption, and poor oral intake.

In this retrospective cohort study, physostigmine administration to reverse anticholinergic delirium had a good safety profile, and often improved or resolved anticholinergic delirium when administered in doses less than 2 mg.

Summary What is known and objective Baking soda is a common household product promoted by the manufacturer as an antacid. It contains sodium bicarbonate and has the potential for significant toxicity when ingested in excessive amounts. Characterizing the patterns and outcomes from the misuse of baking soda as a home remedy can guide the clinical assessment and preventative counselling of patients at risk for use of this product. Methods We conducted a retrospective review of all symptomatic cases involving ingestion and misuse of a baking soda powder product that were reported to the California Poison Control System between the years 2000 and 2012. Results and discussion Of the 192 cases we identified, 55·8% were female, ages ranged 2 months to 79 years, and the most common reasons for misuse included antacid (60·4%), ‘beat a urine drug test’ (11·5%) and treat a UTI (4·7%). Most cases (55·2%) had significant symptoms warranting a medical evaluation, whereas 12 patients required hospital admission developed either electrolyte imbalances, metabolic alkalosis or respiratory depression. What is new and conclusion Misuse of baking soda can result in serious electrolyte and acid/base imbalances. Patients at highest risk of toxicity may include those who chronically use an antacid, those who use the method to ‘beat’ urine drug screens, pregnant women and young children. Self‐treatment with baking soda as a home remedy may also mask or delay medical care thereby complicating or exacerbating an existing medical problem. We suggest that healthcare providers counsel high‐risk patients about the potential complications of misuse of baking soda as a home remedy.

Recreational use of 4-FA may present with life threatening toxicity including cardiomyopathy, cardiogenic shock, and pulmonary edema.

A 50-year-old man with a past medical history of diabetes mellitus, hypertension, and Zollinger-Ellison syndrome came to the emergency department (ED) with a history of increasing vomiting and diarrhea for 1 week and poor oral intake for a few days. He described generalized weakness and lethargy the day before presentation. During the initial ED evaluation, he suddenly had an episode of ventricular tachycardia treated with a single synchronized cardioversion followed by an amiodarone drip. His initial laboratory investigation revealed marked hypokalemia (potassium 2.0 mEq/L), hyponatremia (sodium 122 mEq/L), hypochloremia (59 mEq/L), and elevated serum bicarbonate (46 mEq/L). The BUN was 8 mg/dL, creatinine was 0.9 mg/dL, and glucose was >600 mg/dL. Arterial blood gases revealed a pH of 7.6, pO 2 100 mm Hg, pCO 2 59 mm Hg, and calculated bicarbonate 60 mEq/L. Serum calcium was 8.1 mg/dL, magnesium 1.6 mg/dL, phosphate 1.3 mg/dL, and albumin 2.7 g/L.On further questioning, it was discovered that the patient had been experiencing persistent heartburn and gastric upset for the past 7 years following gastrinoma removal. He had not been compliant with his usual medication regimens for hypertension, diabetes, and gastric hyperacidity and had been using baking soda as an antacid, adding a teaspoon of the white powder to his drinks on an as-needed basis daily for years.