Abstract
Although metformin is a
safe oral antidiabetic drug, lactic acidosis and renal failure due to overdose
drug intake may be caused to death. The clinical outcome of the cases usage
with toxic doses metformin for suicide was investigated in this study. The data
belonging to the cases usage with overdose metformin for suicide between
September 2009 and May 2017 were retrospectively evaluated. Ten patients were
women all of the 15 patients. Median ages were 34 years (18-68) and 38 (23-58)
years in women and men, respectively. Median dose of metformin was 19.5 g (8.5-30.0) and 24.0 g (14.0-50.0) in
women and men. Six of 15
patients (40%) were diabetics and they had used their drugs
for suicide. Eleven patients (74%) were administered intravenous fluids and
four patients (26%) were applied dialysis. The median dose for metformin was 32.0 g (20.0-50.0)
and 17.0 g (8.5-22.0) in dialyzed and non-dialyzed patients. Hyperlactatemia
was detected in one patient but no renal failure or lactic acidosis. There
were tachypnea in four patients (26%) and hypotension in two patients (13%).
All of these patients with tachypnea and/or hypotension were dialyzed.
Pancreatitis, cardiac arrest or death was seen none of the patients. All of the
patients have no need to dialysis at the hospital discharge and their renal
function tests were normal. If it is not contraindicated, metformin is a drug
used safely in diabetic patients. Severe side effects are very rare used in
therapeutic doses whereas lethal adverse events may be seen in very high doses
taken acutely. Close monitoring and dialysis are life saving approaches in
these situations.
Keywords
References
- Renda F, Mura P, Finco G, Ferrazin F, Pani L, Landoni G. Metformin-associated lactic acidosis requiring hospitalization. A national 10 year survey and a systematic literature review. Eur Rev Med Pharmacol Sci 2013; 17 Suppl 1: 45-9.
- Li Cavoli G, Tortorici C, Bono L, et al. Acute kidney injury associated with metformin. Am J Emerg Med 2011; 29: 568-9.
- Lalau JD, Race JM. Lactic acidosis in metformin-treated patients. Prognostic value of arterial lactate levels and plasma metformin concentrations. Drug Saf 1999; 20: 377-84.
- Stang M, Wysowski DK, Butler-Jones D. Incidence of lactic acidosis in metformin users. Diabetes Care. 1999; 22: 925-7.
- van Berlo-van de Laar IR, Vermeij CG, Doorenbos CJ. Metformin associated lactic acidosis: incidence and clinical correlation with metformin serum concentration measurements. J Clin Pharm Ther 2011; 36: 376-82.
- Aharaz A, Pottegård A, Henriksen DP, Hallas J, Beck-Nielsen H, Lassen AT. Risk of lactic acidosis in type 2 diabetes patients using metformin: A case control study. PLoS One 2018; 13: e0196122.
- Angioi A, Cabiddu G, Conti M, et al. Metformin associated lactic acidosis: a case series of 28 patients treated with sustained low-efficiency dialysis (SLED) and long-term follow-up. BMC Nephrol 2018; 19: 77.
- Perincek G, Edis EC, Güldiken S, Uyanık MŞ. Metformin intoksikasyonuna bağlı gelişen nadir bir tablo: Ağır laktik asidoz ve ani kardiyak arrest. Kartal Eğitim ve Araştırma Hastanesi Tıp Dergisi 2009; XX: 42-4.
- Dell'Aglio DM, Perino LJ, Kazzi Z, Abramson J, Schwartz MD, Morgan BW. Acute metformin overdose: examining serum pH, lactate level, and metformin concentrations in survivors versus nonsurvivors: a systematic review of the literature. Ann Emerg Med 2009; 54: 818-23.
- Dell'Aglio DM, Perino LJ, Todino JD, Algren DA, Morgan BW. Metformin overdose with a resultant serum pH of 6.59: survival without sequalae. J Emerg Med 2010; 39:e77-80.
Abstract
Metformin güvenilir bir oral antidiyabetik olmakla birlikte yüksek dozda
alınmasıyla ortaya çıkabilen laktik asidoz ve böbrek yetmezliği tablosu ölümcül
olabilir. Bu çalışmada intihar amacıyla metformin alan olguların klinik seyri
tartışılmıştır. Eylül 2009-Mayıs 2017 tarihleri arasında kliniğimizde takip
edilen, intihar amaçlı yüksek doz metformin alan olgular değerlendirildi.
Demografik verileri, biyokimya sonuçları, klinik seyirleri ve tedavileri
dosyalarından kaydedildi. Toplam 15 olgunun 10 tanesi kadın, 5 tanesi erkekti.
Medyan yaş kadınlarda 34 yıl (18-68), erkeklerde 38 yıl (23-58) saptandı. Alınan
medyan metformin dozu, kadınlarda 19,5 g (8,5-30,0), erkeklerde 24,0 g
(14,0-50,0) bulundu. Altı hastanın (%40) diyabetik olduğu ve kendi kullandıkları metformin
preparatlarını aldıkları görüldü. Hipoglisemi iki olguda (%13) izlendi. Dört
olguya (%26) hemodiyaliz uygulandığı ve 11 olgunun (%74) iv hidrasyonla takip
edildiği belirlendi. Alınan medyan metformin dozu hemodiyaliz uygulanan
hastalarda 32,0 g (20,0-50,0), uygulanmayanlarda 17,0 g (8,5-22,0) idi. Bir hastada hiperlaktatemi
saptanırken böbrek fonksiyon bozukluğu ve asidoz yoktu. Takipne dört hastada
(%26), hipotansiyon iki hastada (%13) mevcuttu. Takipne ve hipotansiyon görülen
hastaların hepsi hemodiyalize alınan hastalardı. Hiçbir hastada pankreatit,
kardiyak arrest ve ölüm görülmedi. Bu hastaların taburculuk sırasında
hemodiyaliz ihtiyaçları kalmamıştı ve böbrek fonksiyon testleri normale
dönmüştü. Metformin kontrendike olmayan diyabetik hastalarda güvenle kullanılan
bir ilaçtır. Terapötik dozlarda kullanıldığında ciddi yan etkiler çok nadir
görülürken akut yüksek dozlarda ölümcül yan etkiler oluşabilmektedir.
Hastaların yakın takibi ile gerektiği anda erken hemodiyaliz programına
alınması hayat kurtarıcı olmaktadır.
Keywords
References
- Renda F, Mura P, Finco G, Ferrazin F, Pani L, Landoni G. Metformin-associated lactic acidosis requiring hospitalization. A national 10 year survey and a systematic literature review. Eur Rev Med Pharmacol Sci 2013; 17 Suppl 1: 45-9.
- Li Cavoli G, Tortorici C, Bono L, et al. Acute kidney injury associated with metformin. Am J Emerg Med 2011; 29: 568-9.
- Lalau JD, Race JM. Lactic acidosis in metformin-treated patients. Prognostic value of arterial lactate levels and plasma metformin concentrations. Drug Saf 1999; 20: 377-84.
- Stang M, Wysowski DK, Butler-Jones D. Incidence of lactic acidosis in metformin users. Diabetes Care. 1999; 22: 925-7.
- van Berlo-van de Laar IR, Vermeij CG, Doorenbos CJ. Metformin associated lactic acidosis: incidence and clinical correlation with metformin serum concentration measurements. J Clin Pharm Ther 2011; 36: 376-82.
- Aharaz A, Pottegård A, Henriksen DP, Hallas J, Beck-Nielsen H, Lassen AT. Risk of lactic acidosis in type 2 diabetes patients using metformin: A case control study. PLoS One 2018; 13: e0196122.
- Angioi A, Cabiddu G, Conti M, et al. Metformin associated lactic acidosis: a case series of 28 patients treated with sustained low-efficiency dialysis (SLED) and long-term follow-up. BMC Nephrol 2018; 19: 77.
- Perincek G, Edis EC, Güldiken S, Uyanık MŞ. Metformin intoksikasyonuna bağlı gelişen nadir bir tablo: Ağır laktik asidoz ve ani kardiyak arrest. Kartal Eğitim ve Araştırma Hastanesi Tıp Dergisi 2009; XX: 42-4.
- Dell'Aglio DM, Perino LJ, Kazzi Z, Abramson J, Schwartz MD, Morgan BW. Acute metformin overdose: examining serum pH, lactate level, and metformin concentrations in survivors versus nonsurvivors: a systematic review of the literature. Ann Emerg Med 2009; 54: 818-23.
- Dell'Aglio DM, Perino LJ, Todino JD, Algren DA, Morgan BW. Metformin overdose with a resultant serum pH of 6.59: survival without sequalae. J Emerg Med 2010; 39:e77-80.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Articles |
| Authors | |
| Publication Date | July 22, 2019 |
| Published in Issue | Year 2018 Volume: 3 Issue: 1 |
