Severe metformin intoxication treated with prolonged haemodialyses and plasma exchange

BACKGROUND: Biguanides pose a significant risk of morbidity, mortality and permanent sequelae secondary to prolonged periods of hypoglycaemia. OBJECTIVES: To investigate the treatment of massive metformin overdose associated with lactic acidosis. CASE REPORT: We present the case of a 30-year-old woman, who attempted to commit suicide by ingesting an 85-g massive metformin overdose associated with severe lactic acidosis, which we treated by performing prolonged haemodialysis with bicarbonate and plasma exchange. CONCLUSION: For the maximum elimination of metformin, extended haemodialysis is required and the treatment of the accompanying metabolic acidosis with bicarbonate is important for the effectiveness of the treatment. Patients benefit much more from the treatment of combined haemodialysis with plasma exchange. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins