Metformin toxicity: A meta-summary of case reports  

作　　者：Deven Juneja Prashant Nasa Ravi Jain 

机构地区：[1]Institute of Critical Care Medicine,Max Super Speciality Hospital,Saket,New Delhi 110017,India [2]Department of Critical Care Medicine,NMC Specialty Hospital,Dubai 7832,United Arab Emirates [3]Department of Critical Care Medicine,Mahatma Gandhi Medical College and Hospital,Jaipur 302022,India

出　　处：《World Journal of Diabetes》2022年第8期654-664,共11页世界糖尿病杂志（英文版）（电子版）

摘　　要：BACKGROUND Metformin is arguably the most commonly prescribed oral hypoglycemic agent for the management of diabetes.Due to the lack of randomized control trials,most of the data pertaining to the clinical course,therapeutic interventions and outcomes of patients with metformin induced toxicity has come from case reports or series.AIM To analyse the symptomology,clinical interventions and outcomes of patients presenting with severe metformin toxicity by reviewing the published case reports and series.METHODS We performed a systematic search from PubMed,Science Direct,Reference Citation Analysis(https://www.referencecitationanalysis.com/)and Google Scholar databases using the terms“metformin”AND“toxicity”OR“overdose”OR“lactic acidosis”OR“hyperlactatemia”.The inclusion criteria were:(1)Case reports or case series with individual patient details;and(2)Reported toxicity or overdose of metformin in adults,published in the English language.Data regarding baseline demographics,clinical presentation,therapeutic interventions,intensive care unit course and overall outcome were collected.RESULTS Two hundred forty-two individual cases were analysed,from 158 case reports and 26 case series,with a cumulative mortality of 19.8%.214(88.4%)patients were diabetics on metformin.57(23.6%)had acute ingestion,but a great majority(76.4%)were on metformin in therapeutic doses when they developed toxicity.Metformin associated lactic acidosis(MALA)was the most commonly reported adverse effect present in 224(92.6%)patients.Most of the patients presented with gastrointestinal and neurological symptoms and a significant number of patients had severe metabolic acidosis and hyperlactatemia.The organ support used was renal replacement therapy(RRT)(68.6%),vasopressors(58.7%)and invasive mechanical ventilation(52.9%).A majority of patients(68.6%)received RRT for toxin removal,renal dysfunction and correction of MALA.Patients with lowest pH and highest serum lactate and metformin levels also had favourable outcomes with use of

关 键 词：Extracorporeal toxin removal HAEMODIALYSIS Metformin associated lactic acidosis Metformin overdose Renal replacement therapy 

分 类 号：R587.1[医药卫生—内分泌]