Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit

Abstract

Objective: To identify the demographics of patients admitted with metformin intoxication and characterize their clinical courses and treatment options in pediatric intensive care unit. Material and Methods: The records of patients admitted to the pediatric intensive care unit due to metformin intoxication between 2013 and 2019 were retrospectively evaluated. Results: There were 22 acute metformin overdose cases. Mean age of the patients was 13.04±5.46 years (1-18 years), 18 were female. Ingested metformin dose ranged from 1.7 gr to 85 gr (mean 19±22.6 gr, median 10 gr), with coingestants taken in 12 patients. Nausea and/or vomiting were present in 16 (72.7%) of the patients. Hyperlactatemia (lactate > 2mmol/L) was present in 13 (59%) of the patients. Mean peak lactate level was 5.1±5.7 mmol/L (0.9-21 mmol/L). Acidosis was present in 12 (54.5%) of the patients. Mean lowest pH level was 7.28±0.16 (6.9-7.45). There was a positive correlation between lactate level and ingested dose (r = 0.816; P < 0.001) while pH was inversely related to dose (r = −0.873; P < 0.001). Six (27%) patients required renal replacement therapy because of profound lactic acidosis despite the intravenous fluid support. Hemodialysis was applied to 5 patients and high dose continuous venovenous hemodiafiltration was applied to 2 patients. 16 years old female patient who ingested 85 g metformin died despite prolonged hemodialysis. Conclusion: Lactic acidosis associated with metformin intoxication is a potentially fatal condition. Both renal replacement therapies hemodialysis and continuous venovenous hemodiafiltration are effective in the treatment of metformin associated lactic acidosis. Most of the patients with severe metformin associated lactic acidosis require repetitive and prolonged hemodialysis sessions.

Keywords

• Metformin intoxication,metformin associated lactic acidosis,hemodialysis,continious venovenous hemodiafiltration

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