Toxicokinetics of metformin overdose treated with CVVHDF

Am J Emerg Med. 2023 Jun:68:216.e1-216.e3. doi: 10.1016/j.ajem.2023.02.038. Epub 2023 Mar 2.

Abstract

A 53-year-old man died following a reported ingestion of 80 g of his metformin tablets resulting in severe, refractory shock and metformin-associated lactic acidosis. His peak serum metformin concentration was 53 μg/mL (therapeutic range 1-2 μg/mL), peak lactic acid concentration was 49.7 mmol/L, and arterial pH nadir was 7.06. He died despite vasopressors and renal replacement therapy [RRT; both intermittent hemodialysis (IHD) and continuous venovenous hemodiafiltration (CVVHDF)]. Serial metformin concentrations during CVVHDF suggested a half-life of 33-h. Similar to previous reports of RRT for metformin toxicity, CVVHDF appears to provide first-order elimination of metformin.

Keywords: CVVHDF; Dialysis; MALA; Metformin.

Publication types

  • Case Reports

MeSH terms

  • Acidosis, Lactic* / chemically induced
  • Acidosis, Lactic* / therapy
  • Continuous Renal Replacement Therapy*
  • Drug Overdose* / therapy
  • Hemodiafiltration* / methods
  • Humans
  • Hypoglycemic Agents
  • Male
  • Metformin*
  • Middle Aged
  • Toxicokinetics

Substances

  • Metformin
  • Hypoglycemic Agents