Severe metformin intoxication with lactic acidosis in an adolescent

A 15-year-old healthy girl ingested 38.25 g (0.55 g/kg body weight) of metformin in a suicide attempt. Subsequently she developed lactic acidosis and moderate renal failure. An initial session of haemodialysis was able to treat the acidosis and reduce the toxic level of metformin. Nevertheless, a fu...

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Bibliographic Details
Published in:European journal of pediatrics 2005-06, Vol.164 (6), p.362-365
Main Authors: LACHER, Martin, HERMANNS-CLAUSEN, Maren, HAEFFNER, Karsten, BRANDIS, Matthias, POHL, Martin
Format: Article
Language:English
Subjects:
Acidosis, Lactic - chemically induced
Acidosis, Lactic - therapy
Acute Kidney Injury - chemically induced
Acute Kidney Injury - therapy
Adolescent
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Drug Overdose - complications
Drug Overdose - therapy
Emergency and intensive care: renal failure. Dialysis management
Female
General aspects
Humans
Intensive care medicine
Medical sciences
Metformin - poisoning
Renal Dialysis - methods
Suicide, Attempted
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Summary:A 15-year-old healthy girl ingested 38.25 g (0.55 g/kg body weight) of metformin in a suicide attempt. Subsequently she developed lactic acidosis and moderate renal failure. An initial session of haemodialysis was able to treat the acidosis and reduce the toxic level of metformin. Nevertheless, a further increase in serum lactate was observed during and after the first dialysis treatment. A second session of haemodialysis was started 5 h after the end of the first session and resulted in a lowering of the lactate level and an almost total elimination of metformin. During the further clinical course, reversible acute renal failure with a maximum creatinine of 2.4 mg/dl was observed. Despite sufficient haemodialysis, the production of lactate can be greater than the elimination in the case of severe metformin intoxication. Therefore haemodialysis should be continued even in the situation of rising lactate levels during the treatment.
ISSN:0340-6199
1432-1076
DOI:10.1007/s00431-005-1634-y