Version May 2024
| To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222 for the nearest regional poison control center. Contact information for poison control centers around the world is available at the WHO website and in the UpToDate topic on regional poison control centers (society guideline links). |
| General information |
| Metformin is an antihyperglycemic agent whose major toxicity is lactic acidosis, which can occur with renal insufficiency, liver disease, and hemodynamic instability |
| Metformin may exacerbate hypoglycemia caused by other agents; taken alone it almost never causes hypoglycemia |
| Clinical features |
| Patients with metformin-induced lactic acidosis may complain of nausea and abdominal pain |
| Examination findings may include tachycardia, tachypnea, and hyperpnea |
| Diagnostic evaluation |
| For all poisoned patients, obtain: fingerstick glucose; ECG; acetaminophen and aspirin blood concentrations; serum pregnancy test in women of childbearing age |
| For suspected metformin toxicity, obtain: basic serum electrolytes, BUN and creatinine, serum bicarbonate, and serum lactate |
| Treatment |
| Secure airway, breathing, and circulation |
| For acute ingestions, give activated charcoal: 1 g/kg (generally 50 g in adults); Do not give activated charcoal to patients with chronic toxicity |
| For patients with profound acidosis (pH <7.10), consider sodium bicarbonate infusion (eg, give 1 to 2 meq/kg IV push; then put approximately 133 meq NaHCO3 in one liter D5W, run at 250 mL/hour in adults, or twice maintenance fluid infusion rate in children) |
| For patients with profound acidosis, highly elevated lactate, renal disease, or critical illness, obtain immediate nephrology consultation; hemodialysis will correct metformin-induced acid-base disturbance and slightly increase metformin clearance |
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
