A Fatal Case of Metformin Poisoning

Severe metformin intoxication with lactic acidosis in an adolescent

“…To our knowledge, the initial metformin level of 165 mg/l is the highest reported metformin level so far in a survivor. There are reports on non-survivors with similar high metformin levels: A 42-year-old diabetic male died due to metformin intoxication with a metformin level of 188 mg/l despite veno-venous haemodialysis and a 50-year-old diabetic male died due to severe lactic acidosis with a metformin level of 166 mg/l without haemodialysis treatment [1,15]. Considering these reports, our patient had a high risk for a fatal outcome.…”

“…Nearly all of them occurred in adult diabetic patients. In three cases the outcome was fatal: a 25-year-old man after ingestion of an unknown number of metformin tablets, a 33-yearold woman after ingestion of 35 g metformin and a 42-year-old man after ingestion of 63 g metformin [15,20]. Intoxications with metformin in childhood are rare.…”

“…The risk of metformin associated lactic acidosis is increased by either chronic or acute renal insufficiency [16]. There are several well documented descriptions of metformin overdose in the literature [5,7,13,15,20]. Nearly all of them occurred in adult diabetic patients.…”

Metformin Overdose With a Resultant Serum pH of 6.59: Survival Without Sequalae

“…Many metformin-exposed patients with significant acidemia described in the literature were found to also be hypothermic to between 27°C and 35°C, thought by some authors to be the result of the associated marked peripheral vasodilatation and hypotension (1,3,4,6,11,15,16).…”

Metformin-Induced Lactic Acidosis with Emphasis on the Anion Gap

“…A metformin level ordered on admission returned as 2.7 mcg/mL. Th e usual therapeutic metformin blood level is in the range of 0.5 to 2.5 mcg/mL (1). Th e patient became progressively hypotensive despite aggressive measures.…”