Severe metformin intoxication with lactic acidosis in an adolescent.
A 15-year-old healthy girl ingested 38.25 g (0.55 g/kg body weight) of metformin in a suicide attempt. Subsequently she developed lactic acidosis and moderate renal failure. An initial session of haemodialysis was able to treat the acidosis and reduce the toxic level of metformin. Nevertheless, a further increase in serum lactate was observed during and after the first dialysis treatment. A second session of haemodialysis was started 5 h after the end of the first session and resulted in a lowering of the lactate level and an almost total elimination of metformin. During the further clinical course, reversible acute renal failure with a maximum creatinine of 2.4 mg/dl was observed.


CONCLUSIONS
Despite sufficient haemodialysis, the production of lactate can be greater than the elimination in the case of severe metformin intoxication. Therefore haemodialysis should be continued even in the situation of rising lactate levels during the treatment.
Lacher
Martin
M
Department of Paediatrics, University Hospital Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany.
Hermanns-Clausen
Maren
M
Haeffner
Karsten
K
Brandis
Matthias
M
Pohl
Martin
M
D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000628:therapy; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D000293:Adolescent; D062787:Drug Overdose / Q000150:complications / Q000628:therapy; D005260:Female; D006801:Humans; D008687:Metformin / Q000506:poisoning*; D006435:Renal Dialysis / Q000379:methods; D013406:Suicide, Attempted
D008687:Metformin
Ann Fr Anesth Reanim. 2003 May;22(5):457-60
12831972
Drugs. 1995 May;49(5):721-49
7601013
Anaesthesist. 2004 Feb;53(2):153-6
14991192
Ann Pharmacother. 2000 Dec;34(12):1385-8
11144693
Diabetes Care. 1992 Jun;15(6):755-72
1600835
Diabet Med. 1985 Sep;2(5):410-1
2951106
Med Klin (Munich). 2002 Feb 15;97(2):99-103
11910877
Presse Med. 1988 Jun 4;17(22):1158
2969545
J Intern Med. 2004 Feb;255(2):179-87
14746555
Xenobiotica. 1994 Jan;24(1):49-57
8165821
Pharmacol Toxicol. 2003 Aug;93(2):98-9
12899672
Ann Intern Med. 2002 Jul 2;137(1):25-33
12093242
Clin Pharmacokinet. 1996 May;30(5):359-71
8743335
Nephrol Dial Transplant. 1997 May;12(5):1046-7
9175069
Drug Saf. 1999 Apr;20(4):377-84
10230584
Diabet Med. 1999 Apr;16(4):273-81
10220200
J Anal Toxicol. 1989 Jul-Aug;13(4):197-8
2779168
J Toxicol Clin Toxicol. 2003;41(7):1035-6
14705855
Anaesthesia. 1998 Jul;53(7):698-701
9771180
Ren Fail. 2002 Sep;24(5):671-5
12380915
Diabetes Care. 1995 Jun;18(6):779-84
7555503