Metformin

Metformin can produce life-threatening lactic acidosis with both therapeutic dosing and in overdose. Lactic poisoning is largely due to lactic acidosis. This may occur in patients on therapeutic doses who develop renal failure or, less commonly, following large acute ingestions. Hypoglycaemia is infrequently reported following metformin overdose is usually minor and easy to correct (in contrast to sulfonylurea poisoning). Early recognition and haemodialysis are life saving.

References

• Guo PYF, StorsleyLJ, Finkle SN.  Severe lactic acidosis treated with prolonged haemodialysis: Recovery after massive overdose of metformin.  Seminars in Dialysis 2006; 19(1):80-83.
• Seidowsky A, Nseir S; Houdret N et al. Metformin-associated lactic acidosis: A prognostic and therapeutic study.  Critical Care Medicine 2009; 37(7):2191-2196.
• Teale KFH, Devine A, Stewart H et al.  The management of metformin overdose.  Anaesthesia 1998; 53:698-701.
• Spiller HA, Weber JA, Winter ML et al.  Multicenter case series of pediatric metformin ingestion. Annals of Pharmacotherapy 2000;3 4:1385-1358.