Successful Treatment of Severe Lactic Acidosis Caused by a Suicide Attempt with a Metformin Overdose

Yang, Penghui; LIN, K. N.; Lo, Su-Huey; Wang, Lee-Ming; Lin, Hong-Da

doi:10.1016/s1607-551x(09)70047-6

Cited by 24 publications

(23 citation statements)

References 21 publications

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“…An acute overdose of metformin can cause a severe lactic acidosis [48][49][50][51]. In such cases, a depressed level of consciousness may occur following several hours of lucidity, although typically it is in the setting of cardiovascular instability [47,[52][53][54][55][56]. Hypothermia, as observed in our patient, has also been well described in acute metformin overdoses [47,54,[57][58][59][60].…”

Section: Could This Be Metformin-associated Lactic Acidosis?supporting

confidence: 57%

“…In such cases, a depressed level of consciousness may occur following several hours of lucidity, although typically it is in the setting of cardiovascular instability [47,[52][53][54][55][56]. Hypothermia, as observed in our patient, has also been well described in acute metformin overdoses [47,54,[57][58][59][60]. Similar to ethylene glycol, at most institutions including our own, metformin measurements are send out tests, with results being available days after empiric clinical management decisions are necessary.…”

Section: Could This Be Metformin-associated Lactic Acidosis?mentioning

confidence: 75%

See 1 more Smart Citation

Case Files from the University of California San Diego Health System Fellowship Coma and Severe Acidosis: Remember to Consider Acetaminophen

Villano

O'Connell

et al. 2015

J. Med. Toxicol.

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A 28-year-old man was brought to the Emergency Department (ED) for evaluation of a depressed level of consciousness that developed while in jail. Sixteen hours previously, he had been arrested on charges of murder. The patient's mental status was reported as normal at the time of arrest, and it had remained so during several hours of interrogation and during the booking process at jail. Following interrogation, the patient was placed into a cell with no other inmates. During the jail intake process, the patient had not reported any history of medical problems nor was he prescribed with any medications. Paramedics arrived to find him unresponsive, but maintaining airway reflexes and hemodynamically stable. They measured a blood glucose of 300 mg/dL and noted one episode of blood-tinged emesis during transport to the ED. No seizure activity was witnessed.On arrival to the ED, vital signs were: heart rate 132/min, blood pressure 129/74 mmHg, temperature 35.3°C (95.5°F), respiratory rate 24/min, and 100 % oxygen saturation on 15 l/ min of oxygen delivered by non-rebreather face mask.Physical examination was notable for a depressed level of consciousness. His eyes remained closed to pain, he withdrew all extremities equally to pain, and he was non-verbal. He had no signs of trauma, and his pupils were normal in size and reactive. Rapid sequence tracheal intubation was performed for airway protection. An electrocardiogram was normal except for sinus tachycardia at a rate of 111/min. An initial peripherally drawn arterial blood gas obtained immediately after intubation revealed: pH 6.97, pCO 2 40 mmHg, pO 2 215 mmHg. A computed tomography scan of the brain was normal. Initial blood chemistry panel was significant for a serum bicarbonate of 7 mEq/L, glucose of 362 mg/dL, and a normal potassium, blood urea nitrogen (BUN), creatinine, and calcium. The initial serum anion gap was 34 mEq/L. Measured serum osmolality was 320 mOsm/kg, yielding an osmol gap of 9 mOsm/kg (using formula of [2(Na)+BUN/2.8+glu-cose/18] for calculated serum osmolarity). Initial lactate was 156.5 mg/dL (normal reference range 4.5-19.8 mg/dL) and beta-hydroxybutyrate (βHB) 2.9 mg/dL (normal reference range 0.0-2.8 mg/dL). Initial liver panel included an aspartate aminotransferase (AST) of 64 U/L, alanine aminotransferase (ALT) of 27 U/L, and bilirubin of 0.4 mg/dL. Prothrombin time was 13.1 s (reference range 9.7-12.5), and lipase was normal at 25 U/L. Initial creatinine phosphokinase (CK) was slightly elevated at 373 U/L (0-175). Urinalysis was positive for small ketones and crystals were not present. Measurements of acetone and acetoacetate were not performed. Serum ethanol and salicylate levels were undetectable, and a urine drug of abuse panel by immunoassay was negative for amphetamines as a class, barbiturates as a class, benzodiazepines as a class, benzoylecgonine (cocaine metabolite), methadone, opiates as class, oxycodone, phencyclidine, and tetrahydrocannabinoids. Iron concentration was normal at 87 mcg/dL.Over the first hour of management,...

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Section: Could This Be Metformin-associated Lactic Acidosis?supporting

confidence: 57%

Section: Could This Be Metformin-associated Lactic Acidosis?mentioning

confidence: 75%

Case Files from the University of California San Diego Health System Fellowship Coma and Severe Acidosis: Remember to Consider Acetaminophen

Villano

O'Connell

et al. 2015

J. Med. Toxicol.

View full text Add to dashboard Cite

show abstract

“…[3536] Metformin has been used in massive quantities with an intent to self-harm in a few patients. [4647484950] Use of excess doses of metformin results in lactic acidosis which may result in cardiac arrest[4750] and even death. [50] Hemodialysis or hemofiltration have been used to correct lactic acidosis in these situations.…”

Section: Introductionmentioning

confidence: 99%

Diabetes mellitus and suicide

Sarkar

Balhara

2014

Indian J Endocr Metab

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Relationship of diabetes mellitus (DM) with metal health disorders such as depression has been explored extensively in the published literatures. However, association of diabetes mellitus with suicidal tendencies has been evaluated less extensively. The present narrative review aimed to assess the literature relating to diabetes mellitus and suicide. As a part of the review, Pubmed and Google Scholar databases were searched for English language peer reviewed published studies with keywords relating to diabetes and suicide. Additional references were identified using cross-references. The available literature suggests that suicidal ideas and attempts are more frequent in patients with diabetes mellitus than healthy or medically ill controls. Although, a few studies report evidence to the contrary. Suicide accounts for a large proportion of deaths in patients with diabetes mellitus type I (T1DM), and their mortality rate is higher than that of age matched control population. Psychological morbidity, including depression, precedes suicidal ideas and attempts; though many other factors can be hypothesized to impact and modulate this association. A common method of suicide attempt in patients with diabetes includes uses of high doses of insulin and its congeners or medications to treat the disease. Regular screening and prompt treatment of depression and suicidality is suggested for patients with DM.

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“…9 Recently, Yang et al reported 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. 10 They pointed out that 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.…”

Section: Discussionmentioning

confidence: 99%

Massive Metformin Overdose in Two Subjects with Suicidal Behavior: Brief Communication

Arıkan¹,

Tuzcu²,

Bahçeci³

et al. 2012

Turkiye Klinikleri J Med Sci

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Successful Treatment of Severe Lactic Acidosis Caused by a Suicide Attempt with a Metformin Overdose

Cited by 24 publications

References 21 publications

Case Files from the University of California San Diego Health System Fellowship Coma and Severe Acidosis: Remember to Consider Acetaminophen

Case Files from the University of California San Diego Health System Fellowship Coma and Severe Acidosis: Remember to Consider Acetaminophen

Diabetes mellitus and suicide

Massive Metformin Overdose in Two Subjects with Suicidal Behavior: Brief Communication

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