SUCCESSFUL MANAGEMENT OF HIGH-DOSE METFORMIN INTOXICATION. ROLE OF VASOPRESSIN IN THE MANAGEMENT OF SEVERE LACTIC ACIDOSIS

We report the case of a 49 year old, 100 kg male patient who, in a suicidal attempt, ingested an estimated dose of 40 to 45 grammes of Metformin. Three hours he presented to AE Department. Due to deterioration of consciousness and a marked irritability, he was sedated, intubated and ventilated at the receiving hospital. On induction of anesthesia (for intubation), the patient hemodynamics became very unstable prompting the initiation of both Epinephrine and Nor-Epinephrine Intra-venous (IV) infusions. Glucose 10% IV infusion and Insulin IV infusion were also started. The pre-transfer management also included Hydrocortisone IV justified by the marked hemodynamic instability and mediocre response to inotropic support. Arterial Blood Gas (ABG) analysis showed severe acidosis and Lactate level of 34 mmol/l, in addition to a Hyperkalemia of 7 mmol/l. He was then transferred to our Intensive Care Unit (ICU) to start Continuous Veno-Venous Hemofiltration (CVVH).