Lactic acidosis secondary to metformin overdose: a case report
Introduction Metformin is a commonly used treatment modality in type 2 diabetes mellitus, with a well documented side effect of lactic acidosis. In the intensive care setting lactate and pH levels are regularly used as a useful predictor of poor prognosis. In this article we highlight how high lact...
| Main Authors: | , , , |
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| Format: | Article |
| Published: |
Biomed Central
2012
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| Online Access: | https://eprints.nottingham.ac.uk/2372/ |
| _version_ | 1848790768048668672 |
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| author | Timbrell, Simon Wilbourn, Gary Harper, James Liddle, Alan |
| author_facet | Timbrell, Simon Wilbourn, Gary Harper, James Liddle, Alan |
| author_sort | Timbrell, Simon |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Introduction
Metformin is a commonly used treatment modality in type 2 diabetes mellitus, with a well documented side effect of lactic acidosis. In the intensive care setting lactate and pH levels are regularly used as a useful predictor of poor prognosis. In this article we highlight how high lactate levels are not an accurate predictor of mortality in deliberate metformin overdose.
Case presentation
We present the case of a 70-year-old Caucasian man who took a deliberate metformin overdose of unknown quantity. He had a profound lactic acidosis at presentation with a pH of 6.93 and a lactate level of more than 20mmol/L. These figures would normally correspond with a mortality of more than 80%; however, with appropriate management this patient’s condition improved.
Conclusion
We provide evidence that the decision to treat severe lactic acidosis in deliberate metformin overdose should not be based on arterial lactate and pH levels, as would be the case in other overdoses. We also demonstrate that appropriate treatment with hemodiafiltration and 8.4% sodium bicarbonate, even in patients with a very high lactate and low pH, can be successful. |
| first_indexed | 2025-11-14T18:17:51Z |
| format | Article |
| id | nottingham-2372 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T18:17:51Z |
| publishDate | 2012 |
| publisher | Biomed Central |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-23722020-05-04T16:33:52Z https://eprints.nottingham.ac.uk/2372/ Lactic acidosis secondary to metformin overdose: a case report Timbrell, Simon Wilbourn, Gary Harper, James Liddle, Alan Introduction Metformin is a commonly used treatment modality in type 2 diabetes mellitus, with a well documented side effect of lactic acidosis. In the intensive care setting lactate and pH levels are regularly used as a useful predictor of poor prognosis. In this article we highlight how high lactate levels are not an accurate predictor of mortality in deliberate metformin overdose. Case presentation We present the case of a 70-year-old Caucasian man who took a deliberate metformin overdose of unknown quantity. He had a profound lactic acidosis at presentation with a pH of 6.93 and a lactate level of more than 20mmol/L. These figures would normally correspond with a mortality of more than 80%; however, with appropriate management this patient’s condition improved. Conclusion We provide evidence that the decision to treat severe lactic acidosis in deliberate metformin overdose should not be based on arterial lactate and pH levels, as would be the case in other overdoses. We also demonstrate that appropriate treatment with hemodiafiltration and 8.4% sodium bicarbonate, even in patients with a very high lactate and low pH, can be successful. Biomed Central 2012-08-02 Article PeerReviewed Timbrell, Simon, Wilbourn, Gary, Harper, James and Liddle, Alan (2012) Lactic acidosis secondary to metformin overdose: a case report. Journal of Medical Case Reports, 6 (230). 230/1-230/4. ISSN 1752-1947 http://www.jmedicalcasereports.com/content/6/1/230/abstract doi:10.1186/1752-1947-6-230 doi:10.1186/1752-1947-6-230 |
| spellingShingle | Timbrell, Simon Wilbourn, Gary Harper, James Liddle, Alan Lactic acidosis secondary to metformin overdose: a case report |
| title | Lactic acidosis secondary to metformin overdose: a case report |
| title_full | Lactic acidosis secondary to metformin overdose: a case report |
| title_fullStr | Lactic acidosis secondary to metformin overdose: a case report |
| title_full_unstemmed | Lactic acidosis secondary to metformin overdose: a case report |
| title_short | Lactic acidosis secondary to metformin overdose: a case report |
| title_sort | lactic acidosis secondary to metformin overdose: a case report |
| url | https://eprints.nottingham.ac.uk/2372/ https://eprints.nottingham.ac.uk/2372/ https://eprints.nottingham.ac.uk/2372/ |