A Rare Case of Mortal Metformin Intoxication

Metformin is the first-line oral antidiabetic for treating type 2 diabetes mellitus (DM). Its major toxicity is lactic acidosis (LA). Metformin‐induced LA (MILA) rarely develops in the absence of an acute overdose. However, LA is the most serious complication of metformin intoxication, and MILA is associated with high mortality rates. We presented a comparative evaluation of a mortal MILA case with the literature. A 47-year-old woman with type 2 DM and using metformin, admitted to the emergency department with abdominal pain and vomiting that started 4 h after taking 60 gr metformin for suicide. There was no abnormality on her initial hemogram, biochemical profile, or coagulation findings. However, her arterial blood gas analysis on admission was remarkable for pH: 7.025 and lactate: 20.32 mmol/L. HD was planned rapidly in the patient with high anion gap metabolic acidosis. Despite the aggressive therapy, the patient developed ventricular fibrillation and then cardiac arrest and died in the 4th hour of her admission to the emergency department. Under acute and high-dose metformin intoxication, metabolic acidosis can develop rapidly. Hemodialysis therapy should not be delayed, particularly in cases with MILA. It should be remembered that these cases are mortal despite aggressive treatment.

Keywords: Hemodialysis, lactic acidosis, metformin, mortality, suicide