Abstract
BackgroundMetformin toxicity is well known to cause lactic acidosis. Multiple cases of hypoglycemia due to isolated metformin overdose have been reported. Increased glucose consumption secondary to anaerobic metabolism has been reported as a possible explanation.Case presentationA 23-year-old Arabic woman took 30 g of metformin. In the emergency department, 4 hours after of the event, she was fatigued but vitally stable. During her hospitalization, she had severe lactic acidosis, hypotension corrected with fluid boluses and vasopressors, and multiple episodes of hypoglycemia (6.3 mg/dL, 38 mg/dL, and 42 mg/dL), requiring multiple 50% dextrose-water boluses. The three hypoglycemic episodes occurred coincident with severe lactic acidosis. She improved after 24 hours of continuous renal replacement therapy.ConclusionsHypoglycemia can be induced by metformin toxicity in the absence of co-ingestants. A possible explanation of metformin-induced hypoglycemia is increased glucose consumption due to anaerobic metabolism, decreased oral intake, decreased liver glucose production, and decreased glucose absorption.
Highlights
Metformin toxicity is well known to cause lactic acidosis
Hypoglycemia can be induced by metformin toxicity in the absence of co-ingestants
We report a case of metformin toxicity in a young girl who had recurrent hypoglycemic episodes despite the absence of any co-ingestion
Summary
Hypoglycemia can be induced by metformin toxicity in the absence of other co-ingestions, and close monitoring of blood glucose is crucial. One possible explanation of metformin-induced hypoglycemia is increased glucose consumption secondary to anaerobic metabolism, other mechanisms like decreased oral intake, decreased liver glucose production, and decreased glucose absorption are of consideration. AA reviewed the contents and was involved in writing and proofreading the body text of the manuscript. BM revised the scientific content and gave final approval for the version to be submitted. All the authors participated in writing and editing the manuscript, and approved the final manuscript. Ethics approval and consent to participate Not applicable. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Author details 1Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. Author details 1Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. 2King Fahad Medical City, Riyadh, Saudi Arabia
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