Prolonged Hemodialysis for Severe Metformin Intoxication
Open accessAbstract
Lactic acidosis is a rare and often lethal complication of metformin therapy. We describe a patient who ingested at least 52 g, and possibly more, of metformin and presented with severe lactic acidosis and acute renal failure. He was treated with prolonged hemodialysis: a 3.5 h treatment that did not result in significant clinical improvement, followed by an additional 31 h treatment. With this treatment regimen, his lactate levels gradually decreased and his clinical status improved. A metformin level drawn approximately 25 h after the initiation of the second hemodialysis treatment was still elevated at about five times the upper therapeutic limit. It is suggested that prolonged dialysis is indicated in patients with severe metformin overdose, particularly those with renal failure. In patients whose cardiovascular status permits, prolonged hemodialysis should be strongly considered.
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The evidence strongly suggests that further inhibition of mitochondrial function would worsen and contribute to toxic effects of metformin, such as lactic acidosis.
“the evidence strongly suggests that further inhibition of function would worsen, and contribute to, the toxic effects of metformin, such as lactic acidosis, that are, albeit very rare (11).”
From A Critical Review of the Evidence That Metformin Is a Putative Anti-Aging Drug That Enhances Healthspan and Extends Lifespan (2021) · cites this paper as [11]
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References 18 · Cited by 26
Research works printed but not linked: 2
- Bailey CJ, Turner RC. Metformin. N Eng J Med. 1996; 334:574-579.
- Guo PY, Storsley LJ, Finkle SN. Severe lactic acidosis treated with prolonged hemodialysis: Recovery after massive over- doses of metformin. Semin Dial. 2006;19:80-83.
- Authors
- Rifkin, S. I., McFarren, C., Juvvadi, R., & Weinstein, S. S.
- Affiliations
- University of South Florida (US)
- Tampa General Hospital (US)
- Corresponding author
- Rifkin, Stephen I.
- Venue
- Renal Failure
- Publisher
- Informa UK Limited
- Published
- 2011-04-30
- Volume
- 33
- Issue
- 4
- Pages
- 459-461
- ISSN
- 0886-022X (ISSN-L)
- 1525-6049
- OpenAlex
- W2028799957
- Cited by
- 26
- References
- 18
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 1 · 2018: 3 · 2016: 2 · 2015: 4 · 2014: 1 · 2013: 3 · 2012: 3
- FWCI
- 2.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Renal Failure (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Keywords
- metformin overdose, lactic acidosis, acute kidney injury, drug poisoning, lactate clearance
- MeSH terms
- Acidosis, Lactic, Renal Dialysis, Humans, Hypoglycemic Agents, Male, Metformin, Middle Aged, Poisoning, Acute Kidney Injury, Drug Overdose
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