title: A severe case of vasoplegic shock following metformin overdose successfully treated with methylene blue as a last line therapy.
abstract: A 44-year-old man presented to hospital 24 h after an intentional overdose of metformin and gliclazide. He had a critical metabolic acidosis on presentation with a pH of 6.88, and very rapidly deteriorated into distributive shock refractory to large volume fluid resuscitation and massive doses of vasopressors. We introduced a methylene blue infusion as a rescue therapy in an attempt to improve the patient's haemodynamics, which was successful. The patient made a full recovery with no long-term sequelae.
authors.affiliation: Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia.
authors.forename: Rachel Erin
authors.initials: RE
authors.lastname: Graham
authors.affiliation: Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia.
authors.forename: Michaela
authors.initials: M
authors.lastname: Cartner
authors.affiliation: Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Winearls
mesh_terms: D000138:Acidosis / Q000188:drug therapy / Q000209:etiology; D000328:Adult; D062787:Drug Overdose / Q000150:complications / Q000188:drug therapy*; D005440:Fluid Therapy; D005907:Gliclazide / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008687:Metformin / Q000008:administration & dosage* / Q000009:adverse effects; D008751:Methylene Blue / Q000627:therapeutic use*; D012769:Shock / Q000188:drug therapy* / Q000209:etiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D056987:Vasoplegia / Q000188:drug therapy* / Q000209:etiology
chemical_list: D014662:Vasoconstrictor Agents; D008687:Metformin; D005907:Gliclazide; D008751:Methylene Blue