Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/17944
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dc.contributor.authorChiew, Angela L-
dc.contributor.authorWright, Daniel F B-
dc.contributor.authorDobos, Nicola M-
dc.contributor.authorMcArdle, Kylie-
dc.contributor.authorMostafa, Ahmed A-
dc.contributor.authorNewth, Annemarie-
dc.contributor.authorRoberts, Michael S-
dc.contributor.authorIsbister, Geoffrey K-
dc.date2018-03-13-
dc.date.accessioned2018-06-21T05:42:58Z-
dc.date.available2018-06-21T05:42:58Z-
dc.date.issued2018-12-
dc.identifier.citationBritish journal of clinical pharmacology 2018; 84(12): 2923-2927-
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/17944-
dc.description.abstractMassive metformin overdose can cause metabolic acidosis with hyperlactatemia. A 55-year-old woman presented 5 h after multidrug overdose, including 132 g extended-release metformin. Continuous venovenous haemodiafiltration (CVVHDF) and noradrenaline were commenced due to metabolic acidosis (pH 7.0, lactate 17 mmol l-1 ) and shock. Despite 3 h of CVVHDF, her acidosis worsened (pH 6.83, lactate 24 mmol l-1 ). Intermittent haemodialysis (IHD) improved acidosis (pH 7.13, lactate 26 mmol l-1 ) but again worsened (pH 6.91, lactate 30 mmol l-1 ) with CVVHDF recommencement. IHD (12 h), CVVHDF (26 h) and vasopressor support for 7 days resulted in survival. Measured metformin concentrations were extremely high with a peak of 292 μg ml-1 at 8 h postingestion. IHD, but not CVVHDF in this case, was associated with improvement in metabolic acidosis and hyperlactataemia. Pharmacokinetic analysis of metformin concentrations found a reduced apparent oral clearance of 8.2 l h-1 and a half-life of approximately 30 h. During IHD, the apparent oral clearance increased to 22.2 l h-1 with an approximate half-life of 10 h. The impact of prolonged oral absorption from a pharmacobezoar and redistribution of metformin from peripheral sites (including erythrocytes) on the pharmacokinetic profile cannot be determined from the data available.-
dc.language.isoeng-
dc.subjectextracorporeal elimination-
dc.subjectmetabolic acidosis-
dc.subjectmetformin-
dc.subjectoverdose-
dc.title'Massive' metformin overdose.-
dc.typeJournal Article-
dc.identifier.journaltitleBritish journal of clinical pharmacology-
dc.identifier.affiliationNew South Wales Poisons Information Centre, Children's Hospital at Westmead, Westmead, New South Wales, Australia-
dc.identifier.affiliationSchool of Pharmacy, University of Otago, Dunedin, New Zealand-
dc.identifier.affiliationIntensive Care Unit, Western Health, Melbourne, Victoria, Australia-
dc.identifier.affiliationSchool of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia-
dc.identifier.affiliationVictorian Poisons Information Centre, Austin Health, Heidelberg, Victoria, Australia-
dc.identifier.affiliationPharmaceutical Chemistry Department, Helwan University, Helwan, Egypt-
dc.identifier.affiliationTranslational Research Institute, Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia-
dc.identifier.affiliationDepartment of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia-
dc.identifier.affiliationClinical Toxicology Research Group, University of Newcastle, Callaghan, New South Wales, Australia-
dc.identifier.doi10.1111/bcp.13582-
dc.identifier.orcid0000-0002-0079-5056-
dc.identifier.orcid0000-0001-9313-9252-
dc.identifier.orcid0000-0003-1519-7419-
dc.identifier.pubmedid29534338-
dc.type.austinJournal Article-
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.cerifentitytypePublications-
item.fulltextNo Fulltext-
item.grantfulltextnone-
item.languageiso639-1en-
item.openairetypeJournal Article-
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