An overdose of metformin or other biguanide agents used to treat diabetes might seem likely to bring blood sugar down rapidly; however, this may not always be the case.
A 29-year-old male attempted suicide by ingestion of unknown quantities of metformin and presented to an emergency department with severe lactic acidosis and an acidic pH reading of 6.73. Following treatment with sodium bicarbonate infusion and continuous venovenous hemodiafiltration, he managed to survive his poisoning experience.
Can You Overdose on Metformin?
Metformin overdose can have serious and potentially life-threatening consequences. It is important to understand the risks associated with metformin overdose, the symptoms to watch out for, and the necessary steps to seek immediate medical attention.
Here’s what you need to know:
Lactic Acidosis: A Serious Complication
Metformin overdose is linked to a condition called lactic acidosis, where there is an excessive buildup of lactic acid in the body. Lactic acidosis can result in severe complications. Symptoms of metformin overdose and lactic acidosis include:
- Gastrointestinal Issues: Severe nausea, vomiting, diarrhea, and epigastric pain.
- General Symptoms: Thirstiness, loss of appetite, and lethargy.
- Respiratory Changes: Hyperpnea (rapid deep breathing).
- Additional Clinical Features: Hypotension, hypothermia, acute renal failure, coma, and cardiac arrest.
Serious Consequences, but Relatively Uncommon
While metformin overdoses are not very common, they can have significant consequences. Lactic acidosis has been reported in approximately 1.6% of metformin exposures reported to poison control centers. It’s worth noting that only 10% of these exposures are deliberate overdoses.
In some cases, metformin overdose may also lead to hyperglycemia, although this is less frequent compared to hypoglycemia.
No Specific Antidote, but Supportive Care is Vital
There is no specific antidote available for metformin overdose. If an overdose is suspected, the focus of treatment is on providing supportive care and managing any complications that may arise, including lactic acidosis.
Early diagnosis and intervention play a crucial role in increasing the likelihood of a successful outcome.
Seek Immediate Medical Attention
If you suspect a metformin overdose, it is absolutely vital to seek immediate medical attention. Contact emergency services or go to the nearest emergency department without delay. Prompt medical intervention can help prevent or minimize the potential risks associated with metformin overdose.
Remember, if you have any concerns or questions about metformin usage or dosage, consult with your healthcare provider for guidance.
Other Side Effects of this drug
Kidney Damage
Lactic acidosis is a serious and potentially life-threatening side effect of taking metformin, occurring when too much of it builds up in your body. You are especially at risk if you have kidney disease, are over 80 years old, suffer from severe infection or drink less water than usual for any reason.
People with severe liver or kidney conditions should avoid taking metformin as this medication increases your risk for rhabdomyolysis (breakdown of muscle tissue).
Metformin has become the go-to drug for diabetes since its creation in the 1950s, first available worldwide from 1977 due to an elevated incidence of lactic acidosis.
Though case series have documented high fatality rates from metformin overdose, new data from Taiwanese patients with moderate-to-advanced chronic kidney disease provides additional insights into potential risks of unrestricted metformin use within this population. Among other symptoms this patient experienced severe hypoglycemia.
Lactic Acidosis
Lactic acidosis is a potentially life-threatening side effect of metformin that occurs when too much lactic acid accumulates in your blood. This condition should be treated immediately as it constitutes a medical emergency and requires treatment at an urgent care facility.
If you have had a severe infection or heart failure, your chances of lactic acidosis increase significantly. Older adults or those suffering from liver disease also increase the likelihood of this problem forming.
Rare, but nonetheless important: it’s essential that you consult your physician about the risk for this adverse side effect when taking this medication. Alcohol should also be avoided while on this treatment; and any surgery or type of x-ray or CT scan requiring dye injection must be stopped immediately if using this drug is part of a treatment plan.
Low Blood Sugar
Metformin is often prescribed in combination with other drugs to lower blood sugar levels, including insulin production by your body, helping you consume less food, and making you less hungry.
To be effective, taking Metformin on a regular basis – either tablets, liquid, or extended release pills once daily with dinner will all do just that – and reading through both patient information leaflets and doctor instructions carefully prior to beginning this treatment as well as each time your prescription refill comes through is key to its effectiveness.
Metformin overdoses are relatively rare. One case involved a 16-year-old girl who consumed an unknown quantity during a suicide attempt. As a result, she experienced severe lactic acidosis which put her into shock, necessitating extracorporeal life support (ECMO).
While metformin doesn’t usually cause hypoglycemia itself, an overdose could still produce low blood sugar. Overdosing can result in nausea, vomiting, weakness, stomach upset, diarrhea or low vitamin B12. Always consult with your physician before altering doses or medications.
Final Thoughts
Metformin comes in liquid and tablet forms that can be taken orally by mouth. Taking two or three doses each day with meals should help control diabetes symptoms.
As part of combination therapy with diet and exercise, Metformin should also be reported to your healthcare provider or pharmacist along with all prescription and over-the-counter medicines as well as vitamins, herbs, or other dietary supplements you take.
Metformin overdose often leads to lactic acidosis. This condition occurs because metformin inhibits gluconeogenesis and leads to excess lactate build-up in the body; normally excreted through urine; however if severe kidney damage or overdose has taken place this buildup could surpass kidneys’ capacity for clearance and become toxic to organs and systems throughout.
29-year-old man took an overdose of 60 grams, or approximately 60,000 milligrams, of metformin and died due to severe lactic acidosis. Meanwhile, 16-year-old girl attempted suicide by ingestion 30 to 35 850 mg tablets; hospitalized for 48 hours as she succumbed to multi-organ failure and ultimately passed away from that cause.
