Table 2.
Case reports of intentional overdose resulting in metformin-associated lactic acidosis, in chronological order grouped by survival and deatha.
| Case | Age in years, sex | Diabetic yes or no | Amount grams | Peak metformin level μg/mL | Nadir pH | Nadir HCO3 mmol/L | Peak lactate mmol/L | Peak creatinine μmol/L | Glucose mmol/Lb | RRT mode |
|---|---|---|---|---|---|---|---|---|---|---|
| Survived | ||||||||||
| Present case | 43, Fc | No | 90 | 170 | 6.56 | 3 | 18.4 | 162 | 1.2 | HDCVVHF |
| Rathnapala et al. [4] | 18, Fc | No | 17.5 | — | 7.08 | <3 | 60.0 | >900 | 2.3 | HD |
| Rifkin et al. [5] | 50, M | Yes | 52 | 10.2 | 6.84 | 3 | 21.2 | 371 | — | HDCVVHDF |
| Akoglu et al. [6] | 34, M | No | 144.5 | — | 7.10 | 3.6 | 17.8 | 239 | 7.9 | HD |
| Dell'Aglio et al. [7] | 40, F | — | 75–100 | 160 | 6.59 | 5 | 40.0 | 203 | — | HD |
| Turkcuer et al. [8] | 30, F | — | 85 | — | 6.88 | 7.3 | 22.4 | 220 | 8.3 | HDPLEX |
| Yang et al. [9] | 43, F | Yes | — | — | 6.99 | 4.7 | 39.3 | 716 | 0.9 | HDCVVHF |
| Basturk et al. [10] | 25, F | No | 100 | — | 7.16 | 9.7 | 17.7 | 147 | 6.1 | None |
| Galea et al. [11] | 46, Mc | Yes | 56 | — | 6.80 | 3.9 | >15 | 368 | 8.2 | CVVHFHD |
| Guo et al. [12] | 37, Mc | Yes | 45 | — | 6.81 | 4 | >30.0 | — | — | HDHD + HP |
| 53, Mc | Yes | 50 | — | 6.85 | 3 | >30.0 | — | — | HD | |
| Panzer et al. [13] | 42, M | Yes | — | 191 | 6.89 | 6.7 | 25.8 | 159 | — | HDCVVHF |
| Gjedde et al. [14] | 70, M | Yes | 63 | — | 7.04 | 9.2 | 23.6 | 216 | 0.4 | HD |
| Chang et al. [15] | 58, Fc | Yes | 55 | — | 6.80 | 1.8 | 5.5 | 194 | 5.2 | HD |
| Teale et al. [16] | 60, Mc | Yes | 50 | — | 6.9 | 4 | 32 | 526 | 7 | CVVHDF |
| Heaney et al. [17] | 29, Mc | No | — | — | 6.96 | 2 | 31 | 398 | 0.6 | HD |
| McLelland [18] | 83, F | Yes | 25 | 42 | 6.98 | 4 | 25 | — | 14 | None |
|
| ||||||||||
| Died | ||||||||||
| Perrone et al. [19] | 40, Fc | No | — | 150 | 6.95 | 25 | 21 | — | 7.8 | HD |
| Arroyo et al. [20] | 49, Fc | Yes | 30 | 380 | 6.79 | 3.1 | 39.1 | 106 | 32.1 | CVVHF |
| Suchard and Grotsky [21] | 29, Mc | No | 64–85 | — | 6.95 | 6 | >11.1 | 186 | 39.2 (peak) | HD |
| Nisse et al. [22] | 42, M | Yes | — | 188 | 6.88 | 2.9 | 27 | 163 | 16.4 | CVVHD |
| Barrueto et al. [23] | 58, Mc | Yes | 20 | 110 | 6.6 | <5 | 33.3 | 221 | — | CVVHD |
| Chang et al. [15] | 25, F | No | — | — | 7.10 | 4.4 | 33.2 | 141 | 10.9 | CVVHD CVVHDF |
| Teale et al. [16] | 25, M | Yes | — | — | 6.79 | 2.1 | 25 | — | 0.3 | CVVHDF |
| 33, F | Yes | 35 | — | 6.7 | 5.1 | — | — | 2 | None | |
aReported values are shown.
bUnless otherwise stated, reported or nadir glucose values are shown.
cRepresents reported polypharmacy overdose.
CVVHD: continuous veno-venous hemodialysis, CVVHDF: continuous veno-venous hemodiafiltration, CVVHF: continuous veno-venous hemofiltration, F: female, HCO3: bicarbonate, HD: hemodialysis, HP: hemoperfusion, M: male, pH: potential hydrogen, PLEX: plasma exchange, RRT: renal replacement therapy.