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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.
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February 2, 2021 at 11:08 am
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.