title: Fatal metformin intoxication with markedly elevated blood and liver concentrations.
abstract: The highest postmortem metformin concentrations are recorded utilizing a sensitive and specific analytical procedure. The peripheral blood metformin concentration was 240 mg/L, the liver concentration was 240 mg/kg and the gastric concentration was 1,700 mg. Additionally, an antemortem blood sample collected shortly after admission revealed a metformin concentration of 210 mg/L. These data, revealing a liver to peripheral blood ratio of 1.0, provide additional support that metformin is not subject to postmortem redistribution. Intentional self-poisonings with metformin can result in death, despite multiple medical interventions.
authors.affiliation: California Poison Control System, San Diego Division and Clinical Pharmacy, University of California San Francisco School of Pharmacy, 200 W. Arbor Dr., San Diego, CA 92103, USA. lcantrell@calpoison.org
authors.forename: Lee F
authors.initials: LF
authors.lastname: Cantrell
authors.forename: Craig L
authors.initials: CL
authors.lastname: Nelson
authors.forename: Ray D
authors.initials: RD
authors.lastname: Gary
authors.forename: Iain M
authors.initials: IM
authors.lastname: McIntyre
mesh_terms: D061605:Administration, Intravenous; D000932:Antiemetics / Q000008:administration & dosage; D001344:Autopsy / Q000379:methods; D062787:Drug Overdose; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008099:Liver / Q000737:chemistry*; D008110:Liver Extracts / Q000032:analysis*; D008687:Metformin / Q000097:blood* / Q000506:poisoning*; D008875:Middle Aged; D013048:Specimen Handling; D013405:Suicide; D014018:Tissue Distribution
chemical_list: D000932:Antiemetics; D008110:Liver Extracts; D008687:Metformin