Biomaterial Database

Toxicokinetics of metformin overdose treated with CVVHDF. 2023

Brian Lewis, and Daniel Brooks, and Christopher Dion, and Courtney Schwebach

University Medical Center Phoenix, University of Arizona College of Medicine Toxicology Fellowship, 1111 E McDowell Rd, Building A, Fl 2, Phoenix, AZ 85006-2749, USA. Electronic address: brianglewis14@gmail.com.

A 53-year-old man died following a reported ingestion of 80 g of his metformin tablets resulting in severe, refractory shock and metformin-associated lactic acidosis. His peak serum metformin concentration was 53 μg/mL (therapeutic range 1-2 μg/mL), peak lactic acid concentration was 49.7 mmol/L, and arterial pH nadir was 7.06. He died despite vasopressors and renal replacement therapy [RRT; both intermittent hemodialysis (IHD) and continuous venovenous hemodiafiltration (CVVHDF)]. Serial metformin concentrations during CVVHDF suggested a half-life of 33-h. Similar to previous reports of RRT for metformin toxicity, CVVHDF appears to provide first-order elimination of metformin.

UI	MeSH Term	Description	Entries
D007004	Hypoglycemic Agents	Substances which lower blood glucose levels.	Antidiabetic,Antidiabetic Agent,Antidiabetic Drug,Antidiabetics,Antihyperglycemic,Antihyperglycemic Agent,Hypoglycemic,Hypoglycemic Agent,Hypoglycemic Drug,Antidiabetic Agents,Antidiabetic Drugs,Antihyperglycemic Agents,Antihyperglycemics,Hypoglycemic Drugs,Hypoglycemic Effect,Hypoglycemic Effects,Hypoglycemics,Agent, Antidiabetic,Agent, Antihyperglycemic,Agent, Hypoglycemic,Agents, Antidiabetic,Agents, Antihyperglycemic,Agents, Hypoglycemic,Drug, Antidiabetic,Drug, Hypoglycemic,Drugs, Antidiabetic,Drugs, Hypoglycemic,Effect, Hypoglycemic,Effects, Hypoglycemic
D008297	Male		Males
D008687	Metformin	A biguanide hypoglycemic agent used in the treatment of non-insulin-dependent diabetes mellitus not responding to dietary modification. Metformin improves glycemic control by improving insulin sensitivity and decreasing intestinal absorption of glucose. (From Martindale, The Extra Pharmacopoeia, 30th ed, p289)	Dimethylguanylguanidine,Dimethylbiguanidine,Glucophage,Metformin HCl,Metformin Hydrochloride,HCl, Metformin,Hydrochloride, Metformin
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000079664	Continuous Renal Replacement Therapy	Procedures with continuous blood purification (e.g., dialysis, filtration or perfusion) via vascular access designed to mimic kidney function in kidney diseases (e.g., ACUTE RENAL FAILURE and poisoning).	CAVHD,CRRT Technique,CVVH Technique,CVVHD,CVVHDF,Continuous Arterio-Venous Ultrafiltration,Continuous RRT,Continuous Renal Replacement Procedure,Continuous Veno-Venous Hemodiafiltration,Continuous Veno-Venous Hemodialysis,Continuous Veno-Venous Hemofiltration,Continuous Venovenous Hemodiafiltration,Continuous Venovenous Hemodialysis,Continuous Venovenous Hemofiltration,Hemofiltration, Continuous Arteriovenous,SCUF Technique,Slow Continuous Ultrafiltration,Arterio-Venous Ultrafiltration, Continuous,Arteriovenous Hemofiltration, Continuous,CVVH Techniques,Continuous Arterio Venous Ultrafiltration,Continuous Arterio-Venous Ultrafiltrations,Continuous Arteriovenous Hemofiltration,Continuous Arteriovenous Hemofiltrations,Continuous RRTs,Continuous Veno Venous Hemodiafiltration,Continuous Veno Venous Hemodialysis,Continuous Veno Venous Hemofiltration,Continuous Veno-Venous Hemodiafiltrations,Continuous Veno-Venous Hemodialyses,Continuous Veno-Venous Hemofiltrations,Continuous Venovenous Hemodiafiltrations,Continuous Venovenous Hemodialyses,Continuous Venovenous Hemofiltrations,Hemodiafiltration, Continuous Veno-Venous,Hemodiafiltration, Continuous Venovenous,Hemodialysis, Continuous Veno-Venous,Hemodialysis, Continuous Venovenous,Hemofiltration, Continuous Veno-Venous,Hemofiltration, Continuous Venovenous,RRT, Continuous,SCUF Techniques,Slow Continuous Ultrafiltrations,Ultrafiltration, Continuous Arterio-Venous,Veno-Venous Hemodiafiltration, Continuous,Veno-Venous Hemodialyses, Continuous,Veno-Venous Hemodialysis, Continuous,Veno-Venous Hemofiltration, Continuous,Venovenous Hemodiafiltration, Continuous,Venovenous Hemodialysis, Continuous,Venovenous Hemofiltration, Continuous
D000140	Acidosis, Lactic	Acidosis caused by accumulation of lactic acid more rapidly than it can be metabolized. It may occur spontaneously or in association with diseases such as DIABETES MELLITUS; LEUKEMIA; or LIVER FAILURE.	Lactic Acidosis
D017583	Hemodiafiltration	The combination of hemodialysis and hemofiltration either simultaneously or sequentially. Convective transport (hemofiltration) may be better for removal of larger molecular weight substances and diffusive transport (hemodialysis) for smaller molecular weight solutes.	Acetate-Free Biofiltration,Biofiltration, Acetate-Free,Acetate Free Biofiltration,Acetate-Free Biofiltrations,Biofiltration, Acetate Free,Biofiltrations, Acetate-Free
D062787	Drug Overdose	Accidental or deliberate use of a medication or street drug in excess of normal dosage.	Drug Overdoses,Overdose, Drug,Overdoses, Drug
D066007	Toxicokinetics	The quantitation of the body's metabolism of toxic xenobiotic compounds, as measured by the plasma concentration of the toxicant at various time points.