Please use this identifier to cite or link to this item:
Title: 'Massive' metformin overdose.
Austin Authors: Chiew, Angela L;Wright, Daniel F B;Dobos, Nicola M;McArdle, Kylie;Mostafa, Ahmed A;Newth, Annemarie;Roberts, Michael S;Isbister, Geoffrey K
Affiliation: New South Wales Poisons Information Centre, Children's Hospital at Westmead, Westmead, New South Wales, Australia
School of Pharmacy, University of Otago, Dunedin, New Zealand
Intensive Care Unit, Western Health, Melbourne, Victoria, Australia
School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
Victorian Poisons Information Centre, Austin Health, Heidelberg, Victoria, Australia
Pharmaceutical Chemistry Department, Helwan University, Helwan, Egypt
Translational Research Institute, Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia
Clinical Toxicology Research Group, University of Newcastle, Callaghan, New South Wales, Australia
Issue Date: Dec-2018
Date: 2018-03-13
Publication information: British journal of clinical pharmacology 2018; 84(12): 2923-2927
Abstract: Massive 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.
DOI: 10.1111/bcp.13582
ORCID: 0000-0002-0079-5056
Journal: British journal of clinical pharmacology
PubMed URL: 29534338
Type: Journal Article
Subjects: extracorporeal elimination
metabolic acidosis
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on May 18, 2024

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.