Hyperlactataemia and clinical severity of acute metformin overdose
Abstract
BACKGROUND: Although metformin-associated lactic acidosis is well described, there is less information on metformin overdose and whether it is of similar severity.
AIMS: This study aims to describe the clinical features, laboratory investigations and outcome of acute metformin overdoses.
METHODS: Retrospective case series of acute metformin overdoses (> 3 g) admitted to a toxicology unit over 20 years. Cases were identified from a prospective database and data extracted included demographics, dose, coingestants, clinical effects, investigations, treatment and outcomes.
RESULTS: There were 36 acute metformin overdose cases. Median age 41 years old (15-68 years old); 25 were female. Median ingested dose was 10 g (interquartile range (IQR): 5-16.1 g; range: 3.5-50 g), with coingestants taken in 34 presentations. Gastrointestinal symptoms were present in 12/36, tachycardia in 10, bradycardia in three, hypotension in four and hypoglycaemia in eight. Hypotension and bradycardia were consistent with coingestants taken. Blood pH and lactate levels were available in 25/36. Median lowest pH was 7.35 (IQR: 7.28-7.38) and acidosis (pH 2 mmol/L) without acidosis occurred in 10/25, and hyperlactataemia with acidosis in 11/25; five had lactic acidosis. The median time to peak lactate in 10 presentations with peak lactate > 2 was 6 h (2-19 h). There were six intensive care unit admissions, one for lactic acidosis, and five related to coingestants. There were no deaths.
CONCLUSION: Metformin…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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