Tek Doz Metformin Kullanımına Bağlı Görülen Derin Metabolik Asidoz

Year 2025, Volume: 16 Issue: 2, 70 - 73, 29.06.2025

Kemal Şener , İnan Beydilli , Tamer Çolak , Adem Çakır , Giray Altunok , Raşit Baysal , Ertuğrul Altuğ

Abstract

Giriş: Metformin biguanid ailesine ait ve dünyada diyabet tedavisinde en sık kullanılan ilaçlardan biridir. İlk kez 1957 yılında ticarileştirildi ve sonrasında kullanımı giderek arttı. Metformin tip 2 diyabet tedavisinde ilk farmakolojik ajan olarak önerilmektedir.
Vaka: 29 yaşında kadın hasta acil servise bulantı kusma nedeni ile acil servisimize başvurdu. Hastanın öyküsü sorgulandığında; ishal olmadığını belirtti, üriner enfeksiyon tariflemedi, aldığı gıdalar sorgulandığında sadece kahvaltı yaptığını ve 5 adet yeşil zeytin, avuç içi kadar da ekmek yediğini belirtti, herhangi bir ilaca maruziyeti olmadığını gün boyunca evde olduğunu belirtti. Başvuru anında hastanın genel durum iyi, bilinç açık koopere ve oryante idi. Aynı günün ilerleyen saatlerinde (yaklaşık 8 saat sonra), hasta bilinç düzeyinde azalma ile acil tıbbi hizmetler aracılığıyla acil servise geri getirildi. Paramedikler, 30 mg/dL'lik kan şekeri seviyesi nedeniyle 50 mg intravenöz dekstroz uyguladıklarını bildirdi.
Sonuç: Son dönemde metformin tedavi amacıyla kullanılabildiği gibi zayıflama amacıylada kullanılmaktadır.Metforminin tek doz kullanımının bile ciddi yan etkilere yol açtığı görülmektedir. Hem endikasyon dahilinde hem de endikasyon dışı metformin kullanan kişilerin dikkatli olması gerekir.

Keywords

Laktik asidoz, Metformin, Tek Doz, MALA

Single Dose Metformin-Induced Severe Metabolic Acidosis

Abstract

Introduction: Metformin, a member of the biguanide family, is one of the most widely used drugs in the treatment of diabetes worldwide. It was first commercialized in 1957, and its use has steadily increased since then. Metformin is recommended as the first pharmacological agent in the treatment of type 2 diabetes.
Case Report: 29-year-old female patient presented to our emergency department due to nausea and vomiting. In her history, she denied diarrhea, urinary symptoms suggestive of urinary tract infection, ingestion of any unusual food, use of any other medications or substances, and reported spending the entire day at home. Upon presentation, the patient was in good general condition, awake, alert, and cooperative. Later the same day (approximately 8 hours later), the patient was brought back to the emergency department via emergency medical services with decreased level of consciousness. Paramedics reported administering 50 mg intravenous dextrose due to a blood sugar level of 30 mg/dL.
Conclusion: Recently, metformin has been used for weight loss as well as for therapeutic purposes. It is seen that even a single dose of metformin can cause serious side effects. People who use metformin both within and outside the indication should be careful.

Keywords

Lactic acidosis, Metformin, Single Dose, MALA

References

• 1. Di Mauro S, Filippello A, Scamporrino A, Purrello F, Piro S, Malaguarnera R. Metformin: When Should We Fear Lactic Acidosis? Int J Mol Sci. 2022 Jul 28;23(15):8320. doi: 10.3390/ijms23158320.
• 2. Aroda VR, Knowler WC, Crandall JP, Perreault L, Edelstein SL, Jeffries SL, et al. Metformin for Diabetes Prevention: Insights Gained from the Diabetes Prevention Program/Diabetes Prevention Program Outcomes Study. Diabetologia. 2017;60:1601–1611. doi: 10.1007/ s00125-017-4361-9.
• 3. National Institute for Health and Care Excellence (NICE) Diabetes in Pregnancy: Management from Preconception to the Postnatal Period. National Institute for Health and Care Excellence (NICE); London, UK: 2020. National Institute for Health and Care Excellence: Guidelines.
• 4. American Diabetes Association Professional Practice Committee 15. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2022. Diabetes Care. 2022;45:S232–S243. doi: 10.2337/dc22-S015.
• 5. Dyatlova N, Tobarran NV, Kannan L, North R, Wills BK. Metformin-Associated Lactic Acidosis (MALA). 2023 Apr 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 35593810.
• 6. Graham GG, Punt J, Arora M, Day RO, Doogue MP, Duong JK, et al. Clinical pharmacokinetics of metformin. Clin Pharmacokinet. 2011 Feb;50(2):81-98.
• 7. Calello DP, Liu KD, Wiegand TJ, Roberts DM, Lavergne V, Gosselin S, et al. Extracorporeal Treatment for Metformin Poisoning: Systematic Review and Recommendations Fromthe Extracorporeal Treatments in Poisoning Workgroup. Crit Care Med. 2015 Aug;43(8):1716-30.
• 8. Wang GS, Hoyte C. Review of Biguanide (Metformin) Toxicity. J Intensive Care Med. 2019 Nov-Dec;34(11-12):863-876
• 9. Hunter RW, Hughey CC, Lantier L, Sundelin EI, Peggie M, Zeqiraj E, et al. Metformin reduces liver glucose production by inhibition of fructose-1-6-bisphosphatase. Nat Med. 2018 Sep;24(9):1395-1406.
• 10. Al-Abri SA, Hayashi S, Thoren KL, Olson KR. Metformin overdose-induced hypoglycemia in the absence of other antidiabetic drugs. Clin Toxicol (Phila). 2013 Jun;51(5):444-7.
• 11. Seidowsky A, Nseir S, Houdret N, Fourrier F. Metforminassociated lactic acidosis: a prognostic and therapeutic study. Crit Care Med. 2009 Jul;37(7):2191-6. doi: 10.1097/ CCM.0b013e3181a02490. PMID: 19487945.
• 12. Peake KN, Tessier S, Longo S, Stahlnecker DM, Idahosa O, Zanders T, et al. Metformin toxicity in the intensive care unit: A case series and review of the literature. Int J Crit Illn Inj Sci. 2024 Jan-Mar;14(1):51-58. doi: 10.4103/ijciis.ijciis_46_23. Epub 2024 Mar 27. PMID: 38715749; PMCID: PMC11073643
• 13. Theobald J, Schneider J, Cheema N, DesLauriers C. Time to development of metformin-associated lactic acidosis. Clin Toxicol (Phila) 2020;58:758–62.
• 14. Reynolds HV, Pollock HH, Apte YV, Tabah A. Achieving high dialysis dose via continuous renal replacement therapy in the setting of metformin associated lactic acidosis: A case series. A A Pract. 2022;16:e01561.
• 15. Wang GS, Hoyte C. Review of Biguanide (Metformin) Toxicity. J Intensive Care Med. 2019 Nov-Dec;34(11-12):863-876.
• 16. Sener K, Arslan B, Ozselcuk S, Guven R. Resistant Lactic Acidemia Due to Accidental Cheese Starter Culture Ingestion. American Journal of Emergency Medicine. 2022;60: 228.e1-228.e2.