title: Severe lactic acidosis and rhabdomyolysis following metformin and ramipril overdose.
abstract: We report the case of a 46-yr-old male who developed severe lactic acidosis, cardiorespiratory arrest, and rhabdomyolysis following an overdose of metformin and ramipril. The lactic acidosis was successfully treated with early high-volume continuous veno-venous haemofiltration. Rhabdomyolysis and lower limb compartment syndrome developed later. The patient otherwise made a good recovery. We discuss the management of severe lactic acidosis secondary to metformin overdose and the association with rhabdomyolysis.
authors.affiliation: Department of Anaesthesia and Intensive Care, St Peter's Hospital, Guildford Road, Chertsey KT16 0PZ, UK. marylyse@doctors.org.uk
authors.forename: M
authors.initials: M
authors.lastname: Galea
authors.forename: N
authors.initials: N
authors.lastname: Jelacin
authors.forename: K
authors.initials: K
authors.lastname: Bramham
authors.forename: I
authors.initials: I
authors.lastname: White
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000628:therapy; D000959:Antihypertensive Agents / Q000506:poisoning*; D003161:Compartment Syndromes / Q000139:chemically induced; D062787:Drug Overdose; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D007004:Hypoglycemic Agents / Q000506:poisoning*; D008297:Male; D008687:Metformin / Q000506:poisoning*; D008875:Middle Aged; D017257:Ramipril / Q000506:poisoning*; D012206:Rhabdomyolysis / Q000139:chemically induced*; D013406:Suicide, Attempted
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D008687:Metformin; D017257:Ramipril