Annals of Emergency Medicine
Volume 54, Issue 6 , Pages 818-823 , December 2009

Acute Metformin Overdose: Examining Serum pH, Lactate Level, and Metformin Concentrations in Survivors Versus Nonsurvivors: A Systematic Review of the Literature

  • Damon M. Dell'Aglio, MD

      Affiliations

    • Emory University School of Medicine Department of Emergency Medicine and the Georgia Poison Center, Atlanta, GA
    • Corresponding Author InformationAddress for correspondence: Damon M. Dell'Aglio, MD, Georgia Poison Center, 80 Jesse Hill Jr. Drive SE, Atlanta, GA 30303
    • ,
  • Louis J. Perino, MD, PhD, DVM

      Affiliations

    • Emory University School of Medicine Department of Emergency Medicine and the Georgia Poison Center, Atlanta, GA
    • ,
  • Ziad Kazzi, MD

      Affiliations

    • Emory University School of Medicine Department of Emergency Medicine and the Georgia Poison Center, Atlanta, GA
    • ,
  • Jerome Abramson, PhD

      Affiliations

    • Emory University Rollins School of Public Health Department of Epidemiology, Atlanta, GA
    • ,
  • Michael D. Schwartz, MD

      Affiliations

    • Emory University School of Medicine Department of Emergency Medicine and the Georgia Poison Center, Atlanta, GA
    • ,
  • Brent W. Morgan, MD

      Affiliations

    • Emory University School of Medicine Department of Emergency Medicine and the Georgia Poison Center, Atlanta, GA

Received 20 June 2008 ,Revised 28 April 2009 ,Accepted 29 April 2009.

References 

  1. Bailey CJ, Turner RC. Metformin. N Engl J Med. 1996;334:574–579
  2. Bronstein A, Spyker D, Cantilena L, et al. 2006 Annual report of the American Association of Poison Control Centers National Poison Data System (NPDS) 25th annual report. Clin Toxicol. 2007;45:815–917
  3. Sirtori CR, Pasik C. Re-evaluation of biguanide, metformin: mechanism of action and tolerability. Pharmacol Res. 1994;30:187–228
  4. Ganetsky M, Donner B, Kent KJ, et al. Should we dialyze metformin induced lactic acidosis? (a case report with urine metformin concentrations). J Toxicol Clin Toxicol. 2006;44:661–662
  5. McLelland J. Recovery from metformin overdose. Diabet Med. 1985;2:410–411
  6. Nisse P, Mathieu-Nolf M, Deveaux M, et al. A fatal case of metformin poisoning. J Toxicol Clin Toxicol. 2003;41:1037–1038
  7. Barrueto F, Meggs WJ, Barchman MJ. Clearance of metformin by hemofiltration in overdose. J Toxicol Clin Toxicol. 2002;40:177–180
  8. Bismuth C, Gaultier M, Conso F, et al. Acidose lactique induite par l'ingestion excessive de metformine. Eur J Toxicol. 1976;9:55–57
  9. Lacher M, Hermanns-Clause M, Haeffner K, et al. Severe metformin intoxication with lactic acidosis in an adolescent. Eur J Pediatr. 2005;164:362–365
  10. Assan R, Heuclin C, Ganeval D, et al. Metformin induced lactic acidosis in the presence of acute renal failure. Diabetologia. 1977;13:211–217
  11. Lalau JD, Mourhlhon C, Bergeret A, et al. Consequences of metformin intoxication. Diabetes Care. 1998;21:2036–2037
  12. Larcan A, Lambert H, Laprevote-Heully MC, et al. Le traitement des acidoses lactiques par hemodialyse sur membrane de polyacrylonitrile. Ann Med Nancy Est. 1981;20:989–996
  13. Dell'Aglio DM, Perino LJ, Todino JD, et al. Metformin overdose with a resultant serum pH of 6.59; survival without sequelae. J Emerg Med. 2008;In press
  14. Chang CT, Chen YC, Fang JT, et al. High anion gap metabolic acidosis in suicide: don't forget metformin intoxication—two patients' experiences. Ren Fail. 2002;24:671–675
  15. Salpeter S, Greyber E, Pasternak G, et al. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus (Cochrane Metabolic and Endocrine Disorders Group). Cochrane Database Syst Rev. 2006;4:CD002967

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

 Reprints not available from the authors.

 Supervising editor: Lewis S. Nelson, MD

 Author contributions: DD and LP conducted the literature review, data collection and database search. JA conducted the statistical analysis and statistical editing and revision. DD wrote the initial draft. All authors conceived and designed the study and contributed to editing and revisions. All authors contributed substantially to revisions. DD takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication date: Available online June 25, 2009.

PII: S0196-0644(09)00486-7

doi: 10.1016/j.annemergmed.2009.04.023

Annals of Emergency Medicine
Volume 54, Issue 6 , Pages 818-823 , December 2009

Article Tools

* Image Usage & Resolution