Great CPC: Metformin toxicity

3.5 out of 5 stars Case 23-2013: a 54-Year-old Woman with Abdominal Pain, Vomiting, and Confusion. Kalantar-Zadeh K et al. N Engl J Med 2013 Jul 25;369:374-382. Full Text This is a very instructive case discussion from the Massachusetts General Hospital. A plane was diverted to Boston because one passenger, a 54-year-old woman, developed increasing abdominal pain and vomiting, along with decreasing mental status. After the plane landed, EMS found that here vital signs were fairly unremarkable (HR = 52 bpm). She was not hypoglycemic. Her medical history included type-2 diabetes, hypertension, and chronic renal disease. Medications included enalapril, metformin, glimepiride, nimesulide, imipramine, aspirin, and ibuprofen. Hospital work-up revealed severe anion-gap metabolic acidosis (venous pH = 6.62, serum bicarbonate < 2.0 mmol/L, anion gap 61). Amylase and lipase were elevated. Lactate was 20.3 mmol/L. Admission creatinine was 7.88 mg/dL. CT scan of the abdomen showed evidence of acute pancreatitis. Not surprisingly, the patient’s metformin level as significantly elevated (23 μg/ml, reference range 1 – 2). She improved after several days of supportive care and continuous venovenous hemofiltration. In an excellent discussion of this case, Dr. Kamyar Kalantar-Zadeh from UC-Irvine makes the following points: The history of chronic kidney disease made this patient a poor candidate for treatment with metformin, which is eliminated unchanged by the kidneys. The ...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical acute pancreatitis anion gap metabolic acidosis case discussion case records of the massachusetts general hospital metformin toxicity Source Type: news