1. Accidental metformin overdose with severe lactic acidosis and Acute Kidney Injury treated with prolonged hemodialysis
P. Greco, G. Regolisti, E. Parenti, C. Maccari, R. Antoniotti, E Fiaccadori
Unità Fisiopatologia Insufficienza Renale Acuta e Cronica
Università degli Studi di Parma 1

2. History
A 76-year-old man, discharged 3 days earlier after uncomplicated surgery for inguinal hernia, presented with vomiting, diarrhea, abdominal pain, hypotension, oliguria, lower abdomen and thigh hematoma
Type 2 diabetes, hypertension, severe dilated cardiomyopathy (EF 20-25%), and CKD (usual sCr 1.8 mg/dL, eGFR 36 mL/min/1.73m2).
Medications: metformin 1000 mg tid, ramipril 7.5 mg qd

3. History
A 83-year-old woman was admitted for diarrhea, abdominal pain, confusion, hypotension, oliguria and pyuria
Type 2 diabetes, hypertension, hypothyroidism, CAD and CKD (usual sCr 0.8 mg/dL, eGFR 50 mL/min/1.73m2)
Medications: metformin 850 mg tid, zofenopril 7.5 mg bid, spironolactone 50 mg q.b

4. Laboratory data Patient 1 Patient 2 sGluc 221 mg/dL
sCr 8.1 mg/dL, BUN 96 mg/dL
sNa 136 mmol/L, sK 6.1, sCl 106
pH 6.91, PaO2 100 mmHg, PaCO mmHg
HCO mmol/L AG 27 mmol/L, lactate 17 mmol/L.
sGluc 194 mg/dL
sCr 5.9 mg/dL, BUN 89 mg/dL
sNa 138 mmol/L, sK 4.2, sCl 88
pH 7.15, PaO2 140 mmHg, PaCO2 10 mmHg
HCO3- 6 mmol/L AG 48 mmol/L, lactate 23 mmol/L

5. RRT indications in metformin intoxication
Diane P. Calello at al. Crit Care Med 2015; 43:

6. Metformin: physicochemical and toxicokinetic data
Diane P. Calello at al. Crit Care Med 2015; 43:

7. SLED and serum metformin concentration

8. GFR and metformin dose

9. MALA and mortality
D. Boucaud-Maitre et al. Diabet. Med 2016 in press

10. MALA vs LA and mortality

11. Median Pharmacokinetic-toxokinetic for all techniques
Diane P. Calello at al. Crit Care Med 2015; 43: