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Archivos de Pediatría del Uruguay

Print version ISSN 0004-0584On-line version ISSN 1688-1249


MACHADO, Sergio; HERNANDEZ, Karen; PASCALE, Antonio  and  DALL’ORSO, Patricia. Intentional acute metformin overdose in an adolescent. Case report. Arch. Pediatr. Urug. [online]. 2019, vol.90, n.4, pp.203-209.  Epub Aug 01, 2019. ISSN 0004-0584.

Acute intoxications have a key role in pediatric emergency services, due to its potential life threat. The Montevideo Poison Control Center annually receives an average of 10,000 consultations per year, 45% from patients under 15 years of age. Of the total number of consultations (41,465) in 2003-2006, 5.4% accounted for voluntary suicidal circumstances in the 10 -15 year-old age group. Medications were the most frequent agents used.

We hereby describe the case of a teenager who used Metformin to intend am intentional severe acute poisoning suicide. The main clinical manifestations were nausea, vomiting, abdominal pain, maintained hypotension, transient bradycardia, metabolic acidosis, hyperlactatemia and symptomatic hypoglycemia. There was no evidence of oral hypoglycemic agents or cardiovascular drugs at stake. Metformin intake usually shows symptoms that are not very specific at first, and lactic acidosis usually occurs up to 8 hours after the intake. Metformin poisoning symptoms are rarely severe. The presence of digestive symptoms, metabolic acidosis and elevated lactate should suggest Metformin poisoning. Hypotension is an ominous sign that requires urgent and continuous hemodynamic support and it is often poorly diagnosed. Another concern after Meformin overdose is the progression to lactic acidosis. This metabolic situation will determine the prognosis to be adopted, due to the deleterious effect on cardiovascular function. In absence of hemodialysis, death after the onset of lactic acidosis can be rapid.

Keywords : Metformin; Poisoning; Lactic acidosis; Hypotension; Attempted suicide; Adolescent.

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