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 p H 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. 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 p H 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. We provide evidence that the decision to treat severe lactic acidosis in deliberate metformin overdose should not be based on arterial lactate and p H levels, as would be the case in other overdoses. 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Metformin is a biguanide typically used as a first line drug for the treatment of type 2 diabetes mellitus. Its chief modes of action are reduced absorption of glucose from the gastrointestinal tract, decreased hepatic gluconeogenesis and increased peripheral utilization of glucose. Acute metformin overdose: Examining serum p H lactate Levels and metformin concentrations in survivors versus nonsurvivors: A systematic review of the literature. Annals of Emerg Med 2009; 54: 818-23 Metformin, a blood-glucose-lowering drug widely used for treatment of type 2 diabetes, is associated with risk of potentially fatal metabolic (lactic) acidosis. This can occur not only following overdose but also at therapeutic dose in patients with pre-existing renal or liver disease. Results of arterial blood gas analysis reflect metabolic acidosis (reduced blood p H, reduced bicarbonate compensatory increase in ) and increased plasma lactate. Is it possible, as might be intuitively expected, to predict survival in such cases from the severity of the acidosis and/or severity of the hyperlactatemia? Investigators conducted a systematic review of the literature and identified 22 well-documented case histories of metformin overdose, five of which had a fatal outcome. For each of these cases, investigators abstracted lowest (nadir) p H, highest (peak) plasma lactate concentration and highest (peak) plasma metformin concentration. The median nadir p H among non-survivors was 6.71 (interquartile IQ range 6.71-6.73), this compared with median p H 7.30 (IQ range 7.22-7.36) for survivors. Metformin is a drug commonly prescribed to treat diabetes. Overdosing involving the drug metformin is rare when used alone (without additional diabetic medications) at recommended dosing. Symptoms of metformin overdose result from a condition called lactic acidosis. Lactic acidosis can occur at normal dosages, but is seen predominantly in overdose. Symptoms include abdominal pain, vomiting, diarrhea, tachycardia, agitation, confusion, lethargy, coma, and death. Hypoglycemia (low blood sugar) is seldom seen in patients using metformin. Taking glucose tablets will not treat metformin overdose. Metformin overdose treatment Metformin • Life in the Fast Lane • LITFL • Medical Blog, Metformin - Wikipedia Prednisone withdrawal headacheBuy erythromycin ointment onlineXanax 106 sCheap brand levitraTadalafil 10 mg Treatment for metformin overdose is supportive therapy. The goal of treatment is to achieve a normal acid/base balance in the blood, control heart function, and to remove any excess metformin in the stomach. No antidote or homeopathic remedy is available to help treat metformin overdose at home. How do I Treat a Metformin Overdose? - Health FAQ. Lactic acidosis secondary to metformin overdose a case.. Pharmacology and Toxicology Treatment of Poisons - Metformin.. The patient's peak serum glucose level of 707 mg/dL is the highest yet reported in a case of metformin toxicity. Treatment included sodium bicarbonate infusion. Метформи́н — таблетированное сахароснижающее лекарственное средство класса бигуанидов для приёма внутрь. Этот препарат применяется при лечении сахарного диабета 2-го типа, особенно у лиц с избыточным весом и ожирением и при этом сохранённой нормальной. There are only few cases of Metformin overdose. With this severe acidosis, Metformin overdose. treatment of acidosis8,9,10, but less clear advice is given.