• Am J Emerg Med · Jun 2023

    Case Reports

    Toxicokinetics of metformin overdose treated with CVVHDF.

    • Brian Lewis, Daniel Brooks, Christopher Dion, and Courtney Schwebach.
    • University Medical Center Phoenix, University of Arizona College of Medicine Toxicology Fellowship, 1111 E McDowell Rd, Building A, Fl 2, Phoenix, AZ 85006-2749, USA. Electronic address: brianglewis14@gmail.com.
    • Am J Emerg Med. 2023 Jun 1; 68: 216.e1216.e3216.e1-216.e3.

    AbstractA 53-year-old man died following a reported ingestion of 80 g of his metformin tablets resulting in severe, refractory shock and metformin-associated lactic acidosis. His peak serum metformin concentration was 53 μg/mL (therapeutic range 1-2 μg/mL), peak lactic acid concentration was 49.7 mmol/L, and arterial pH nadir was 7.06. He died despite vasopressors and renal replacement therapy [RRT; both intermittent hemodialysis (IHD) and continuous venovenous hemodiafiltration (CVVHDF)]. Serial metformin concentrations during CVVHDF suggested a half-life of 33-h. Similar to previous reports of RRT for metformin toxicity, CVVHDF appears to provide first-order elimination of metformin.Copyright © 2023 Elsevier Inc. All rights reserved.

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