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Question: Tox

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A 15yo obese patient is brought in after admitting to taking an overdose of “a handful” of metformin as a suicide attempt. No other drugs were available to the patient and co-ingestion is not suspected. 

What is the most important lab test to obtain in the ED to assess degree of toxicity?
24 votes

pemsou5_wp • February 2, 2021

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  1. Kelly February 2, 2021 - 11:08 am Reply

    C) Lactic acid level
    The most significant finding of toxicity of metformin overdose is lactic acidosis. Metformin levels are not routinely available at most hospitals, and do not result fast enough to impact emergency department management. Metformin alone should not make a patient hypoglycemic. Impaired renal or liver function could increase the risk of significant toxicity with metformin overdose, but the most important indicator of toxicity is degree of lactic acidosis.

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