Can acute overdose of metformin lead to lactic acidosis?
Abstract
INTRODUCTION: Metformin-associated lactic acidosis (MALA) is well described in patients taking therapeutic metformin who develop renal failure or other serious comorbid conditions. Metformin-associated lactic acidosis from acute overdose has also been described in case series but is debated by some clinicians, arguing that metformin overdose does not cause lactic acidosis. Our aim was to perform a multicenter poison control database review to determine if MALA can occur in mono-overdose patients with no comorbid conditions.
METHODS: This was a retrospective chart review of the Illinois and Washington Poison Centers between the 2001-2006 and 1999-2006 periods, respectively. Metformin overdoses that were referred to health care facilities were categorized into mono-overdose with or with out MALA and polypharmacy overdose with or without MALA.
RESULTS: The overall prevalence of MALA was 14 (3.5%) of 398 cases referred to a health care facility. Metformin-associated lactic acidosis occurred in 9.1% of mono-overdose and in 0.7% of polypharmacy overdose patients referred to health care facilities and was 16% for intentional mono-overdoses. There was one death of 132 mono-overdoses referred to health care facilities.
CONCLUSIONS: Apparent metformin mono-overdose is associated with MALA. Dosages that place patients at risk for MALA will require additional study.
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.
Read the paper
Related studies
- Metformin as an adjuvant in breast cancer treatment
- Metformin Lysosomal Targeting: A Novel Aspect to Be Investigated for Metformin Repurposing in Neurodegenerative Diseases?
- Aberrant HSF1 signaling activation underlies metformin amelioration of myocardial infarction in mice
- Metformin induces ZFP36 by mTORC1 inhibition in cervical cancer-derived cell lines
- Protein Interaction Network for Identifying Vascular Response of Metformin (Oral Antidiabetic)
- Preventing Long COVID With Metformin
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.