Metformin toxicity, beyond renal failure and lactic acidosis: report of 2 cases
Article Sidebar
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Downloads
Societal impact
Main Article Content
Abstract
Suicide is a serious public health problem that increases worldwide. In Medellín, its incidence is on the rise, and the most frequent mechanism is the ingestion of drugs. Metformin is an antihyperglycemic medication that is easily accessible and frequently used, because it is part of the first line of management of type 2 diabetes mellitus. One of the complications associated with its use is lactic acidosis, which can lead to serious toxicity. Therefore, it is necessary for the health personnel to be aware of the signs and symptoms that can initially appear in the case of intoxication, since a favorable prognosis depends on adequate management. The objective of this report is to present two clinical cases that evidence the wide spectrum of toxicity secondary to the use of metformin and to review the available evidence of the approach to this poisoning, emphasizing the importance of early use of renal replacement therapy.
Article Details
References
WHO. Suicide data [Internet]. WHO; 2020 [citado 4 de noviembre de 2020]. Disponible en: http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/
CNN. Presentaciocc81n-forensis-2018.pdf [Internet]. [citado 4 de noviembre de 2020]. Disponible en: https://cnnespanol.cnn.com/wp-content/uploads/2019/06/presentaciocc81n-forensis-2018. pdf
Gummin DD, Mowry JB, Spyker DA, Brooks DE, Osterthaler KM, Banner W. 2017 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 35th Annual Report. Clin Toxicol 2018;56:1213-415.
Rena G, Hardie DG, Pearson ER. The mechanisms of action of metformin. Diabetologia 2017;60:1577-85.
Ferrannini E. The target of metformin in Type 2 Diabetes. N Engl J Med 2014;371:1547-8.
Madiraju AK, Erion DM, Rahimi Y, Zhang X-M, Braddock DT, Albright RA, et al. Metformin suppresses gluconeogenesis by inhibiting mitochondrial glycerophosphate dehydrogenase. Nature 2014;510:542-6.
Nieto-Ríos J, Sylva D. Enfoque diagnóstico de la acidosis metabólica. En: XXII Simposio de residentes de medicina interna. 2016. p. 73-88.
Dell’Aglio DM, Perino LJ, Kazzi Z, Abramson J, Schwartz MD, Morgan BW. Acute metformin overdose: Examining serum ph, lactate level, and metformin concentrations in survivors versus nonsurvivors: A systematic review of the literature. Ann Emerg Med 2009;54:818-23.
Aldobeaban S, Mzahim B, Alshehri AA. Recurrent hypoglycemia secondary to metformin toxicity in the absence of co-ingestions: A case report. J Med Case Reports 2018;12:223.
Calello DP, Liu KD, Wiegand TJ, Roberts DM, Lavergne V, Gosselin S, et al. Extracorporeal treatment for metformin poisoning: Systematic review and recommendations from from the Extracorporeal Treatments in Poisoning Workgroup. Crit Care Med 2015;43:1716-30.