<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-1249</journal-id>
<journal-title><![CDATA[Archivos de Pediatría del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Arch. Pediatr. Urug.]]></abbrev-journal-title>
<issn>1688-1249</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Uruguaya de Pediatría]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-12492019000400203</article-id>
<article-id pub-id-type="doi">10.31134/ap.90.4.3</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Intoxicación aguda intencional por metformina en una adolescente: a propósito de un caso clínico]]></article-title>
<article-title xml:lang="en"><![CDATA[Intentional acute metformin overdose in an adolescent. Case report]]></article-title>
<article-title xml:lang="pt"><![CDATA[Intoxicação intencional aguda com metformina num adolescente. Relato de caso]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Machado]]></surname>
<given-names><![CDATA[Sergio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Hernández]]></surname>
<given-names><![CDATA[Karen]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pascale]]></surname>
<given-names><![CDATA[Antonio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Dall&#8217;Orso]]></surname>
<given-names><![CDATA[Patricia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,UDELAR Facultad de Medicina Unidad Pediátrica Ambiental]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,UDELAR Facultad de Medicina Emergentología Pediátrica]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,UDELAR Facultad de Medicina Depto. Toxicología]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,UDELAR Facultad de Medicina Depto. Emergencia Pediátrica]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<volume>90</volume>
<numero>4</numero>
<fpage>203</fpage>
<lpage>209</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-12492019000400203&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-12492019000400203&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-12492019000400203&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: Las intoxicaciones agudas en los servicios de emergencia pediátrica ocupan un lugar importante dentro de la patología de urgencia por su potencial riesgo vital. El Centro de Información y Asesoramiento Toxicológico (CIAT) recibe anualmente un promedio de 10.000 consultas, el 45% corresponde a pacientes menores de 15 años. Del total de consultas (41.465) en el período 2003-2006, el 5,4% correspondieron a circunstancias voluntarias suicidas en el grupo etario de 10-15 años. Los medicamentos fueron los agentes más frecuentemente involucrados. Describimos el caso de una adolescente con una intoxicación aguda grave intencional suicida con metformina. Las manifestaciones clínicas más importantes fueron náuseas, vómitos, dolor abdominal, hipotensión mantenida, bradicardia transitoria, acidosis metabólica, hiperlactacidemia e hipoglicemia sintomática. No se evidenció la presencia de hipoglicemiantes orales, ni fármacos cardiovasculares en el escenario. La ingesta de metformina presenta habitualmente al inicio síntomas poco específicos, desarrollando acidosis láctica hasta 8 horas posingesta. Los síntomas graves en la intoxicación con metformina no son frecuentes. La presencia de síntomas digestivos con acidosis metabólica y lactato elevado debe hacer sospechar una intoxicación por metformina. La hipotensión es un signo ominoso que requiere soporte hemodinámico urgente y mantenido, siendo de mal pronóstico. Otra preocupación después de una sobredosis de metformina es la progresión a la acidosis láctica. Esta situación metabólica determinará el pronóstico, dado que es conocido el efecto deletéreo en la función cardiovascular. La muerte después de la aparición de acidosis láctica puede ser rápida en ausencia de hemodiálisis.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Summary: 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.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: As intoxicações agudas têm um papel fundamental nos serviços de emergência pediátrica, devido a seu potencial de ameaça à vida. O Centro de Controle de Intoxicações de Montevidéu recebe anualmente uma média de 10.000 consultas por ano, 45% de pacientes com menos de 15 anos de idade. Do total de consultas (41.465) em 2003-2006, 5,4% aconteceram por circunstâncias de suicídio voluntário nas idades de 10 a 15 anos. Os agentes mais frequentemente utilizados foram os medicamentos. Descrevemos aqui o caso de um adolescente que usou Metformina para intentar um suicídio intencional por intoxicação aguda grave. As principais manifestações clínicas foram náuseas, vómitos, dor abdominal, hipotensão mantida, bradicardia transitória, acidose metabólica, hiperlactatemia e hipoglicemia sintomática. Não houve evidência de hipoglicemiantes orais ou drogas cardiovasculares. A ingestão de Metformina geralmente apresenta sintomas que não são específicos no início, e a acidose láctica geralmente ocorre até 8 horas após a ingestão. Os sintomas de envenenamento por Metformina raramente são graves. A presença de sintomas digestivos, acidose metabólica e lactato elevado pode sugerir intoxicação por Metformina. A hipotensão é uma sinal de risco que requer suporte hemodinâmico urgente e contínuo e, muitas vezes, é pouco diagnosticado. Outra preocupação após a overdose de Meformina é a progressão para a acidose láctica. Essa situação metabólica determinará o prognóstico a ser adotado, devido ao efeito deletério sobre a função cardiovascular. No caso de ausência de hemodiálise, a morte após o início da acidose láctica pode ser rápida.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Metformina]]></kwd>
<kwd lng="es"><![CDATA[Envenenamiento]]></kwd>
<kwd lng="es"><![CDATA[Acidosis láctica]]></kwd>
<kwd lng="es"><![CDATA[Hipotensión]]></kwd>
<kwd lng="es"><![CDATA[Intento de suicidio]]></kwd>
<kwd lng="es"><![CDATA[Adolescente]]></kwd>
<kwd lng="en"><![CDATA[Metformin]]></kwd>
<kwd lng="en"><![CDATA[Poisoning]]></kwd>
<kwd lng="en"><![CDATA[Lactic acidosis]]></kwd>
<kwd lng="en"><![CDATA[Hypotension]]></kwd>
<kwd lng="en"><![CDATA[Attempted suicide]]></kwd>
<kwd lng="en"><![CDATA[Adolescent]]></kwd>
<kwd lng="pt"><![CDATA[Metformina]]></kwd>
<kwd lng="pt"><![CDATA[Envenenamiento]]></kwd>
<kwd lng="pt"><![CDATA[Acidose láctica]]></kwd>
<kwd lng="pt"><![CDATA[Hipotensão]]></kwd>
<kwd lng="pt"><![CDATA[Tentativa de suicidio]]></kwd>
<kwd lng="pt"><![CDATA[Adolescente]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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