Can you od on metformin
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Summary
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Some studies suggest metformin overdose can cause severe toxicity, metabolic acidosis, and potentially death, while other studies indicate that with appropriate acute supportive care, patients can survive even severe overdoses.
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Can You Overdose on Metformin?
Understanding Metformin Overdose
Metformin, a common medication for managing type 2 diabetes, can be dangerous in overdose situations. Overdosing on metformin can lead to severe metabolic complications, primarily lactic acidosis, which can be fatal if not treated promptly and effectively .
Metformin-Associated Lactic Acidosis (MALA)
Mechanism and Symptoms
Metformin-associated lactic acidosis (MALA) is a critical condition characterized by elevated lactate levels and metabolic acidosis. This condition can occur both in therapeutic use, especially in patients with renal impairment, and in overdose scenarios . Symptoms of MALA include severe lactic acidosis, hyperlactatemia, and in some cases, progressive hyperglycemia.
Case Studies and Outcomes
Several case studies highlight the severity of metformin overdose. For instance, a 55-year-old woman who ingested 132 grams of extended-release metformin developed severe metabolic acidosis and required intensive treatments, including continuous venovenous hemofiltration (CVVHDF) and intermittent hemodialysis (IHD), to survive. Another case involved a 29-year-old man who ingested over 60 grams of metformin, leading to severe lactic acidosis and hyperglycemia, ultimately resulting in death despite aggressive treatment.
Factors Influencing Mortality
Serum pH, Lactate, and Metformin Concentrations
Research indicates that the severity of metabolic acidosis, as measured by serum pH, lactate levels, and metformin concentrations, is closely associated with mortality in metformin overdose cases. Patients with a nadir serum pH below 6.9, lactate levels above 25 mmol/L, or metformin concentrations exceeding 50 µg/mL have significantly higher mortality rates. Survivors typically have higher nadir pH levels and lower peak lactate and metformin concentrations compared to nonsurvivors.
Treatment Approaches
Effective management of metformin overdose involves early recognition and aggressive supportive care. Treatments may include sodium bicarbonate infusion, hemodialysis, and continuous renal replacement therapy (CRRT) to correct metabolic acidosis and remove excess metformin from the bloodstream . In some cases, extracorporeal membrane oxygenation (ECMO) has been used to stabilize patients with severe acidosis and hemodynamic instability.
Conclusion
Overdosing on metformin can lead to life-threatening metabolic acidosis, primarily characterized by severe lactic acidosis. The prognosis depends on the severity of acidosis and the promptness of medical intervention. While some patients can survive with aggressive treatment, others may succumb to the complications despite intensive care. Understanding the critical factors and treatment options is essential for managing metformin overdose effectively.
Sources and full results
Most relevant research papers on this topic
4
Fatal Metformin Overdose Presenting with Progressive Hyperglycemia
4
32 Citations
2008