Metformin-related fatalities - The importance of combining forensic toxicology and postmortem biochemistry analyses in death involving antidiabetics
Abstract
Metformin is the most commonly used drug in the treatment of type 2 diabetes mellitus and appears as a promising drug for several other conditions. While generally well-tolerated and relatively safe, metformin can cause serious side effects, and intoxication cases have been reported. Classically, the severity of metformin intoxications is better assessed by measuring lactate blood concentration and/or blood pH than by directly determining blood drug concentration. However, such an approach is more complicated in postmortem investigation. Indeed, biochemistry changes occur after death, affecting both lactate concentration and pH. In this context, the authors report a case of a metformin-related fatality for which toxicological and biochemical analyses have been integrated in order to better understand pathophysiological mechanisms and/or circumstances surrounding such fatalities. Metformin was quantified in femoral blood (FB) (45 mg/L), heart blood (HB) (39 mg/L), urine (464 mg/L), vitreous (18 mg/L) and gastric content (202 mg/L) using liquid chromatography-tandem mass spectrometry (LC-MS/MS). β-hydroxybutyrate (BHB) was also quantified in FB (491 mg/L) and vitreous (473 mg/L) using LC-MS/MS. Vitreous sodium (122 mmol/L), chloride (102 mmol/L), glucose (<0.10 mmol/L), creatinine (277 µmol/L) and lactate (13 mmol/L) concentrations were determined in vitreous on an Atellica® CH 930 analyzer. Glycated hemoglobin (HbA1C) was assessed in FB (7.7 %) using a Tosoh® G8 HPLC…
How strong is the evidence?
Evidence Hub reads this as a case report, 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.