ABSTRACT 652

Abstract

Background and aims: Metformin is a biguanide anti-hyperglycemic agent used in type 2 diabetes to augment insulin sensitivity without lowering glucose concentration below normal. Aims: Metformin, a widely used and promising antidiabetic agent, became a new threat for childhood intoxication. Methods: In this report we present seven cases with metformin ingestion of doses ranging from 3.4 g to 85 g (Table). Results: We would like to emphasize two adolescent girls of 85 g and 70 g metformin intake, much higher than previous cases in literature. 85 g metformin combined with 10 g nateglinid lead to intractable MALA, multiorgan failure, and exitus. The patient with 70 g intake benefited from hemodialysis and hyperbaric oxygen treatment. Conclusions: Metformin intoxication associated lactic acidosis is a potentially fatal condition, which should be urgently treated with prolonged hemodialysis. The primary goal of hemodialysis is clearance of lactate. Hyperbaric oxygen therapy may be administered in selected patients to induce aerobic respiration. Organ failure and shock during MALA predict poor outcome.