Succesful Resusication with Veno-arterial Extracorporeal Membrane Oxygenation in Cardiac Arrest After Metformin Overdose: A Case Report and Current Literature Review

Abstract

Metformin can cause gastrointestinal system symptoms, hyperlactatemia, and lactic acidosis even at therapeutic doses, and toxicity can result in serious complications and high mortality with massive infections. The prognosis for undifferentiated lactic acidosis is poor, with an expected case fatality rate of 30-50%. We present the case of a patient who was admitted to the emergency department with a large intentional metformin overdose. The patient was initially asymptomatic, but deteriorated rapidly during the observation period, developed cardiac arrest, and required extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy. Considering this case, we aim to emphasize that metformin overdoses may worsen in the late stages and that the follow-up period should be performed in a monitored setting that can provide, if needed, advanced cardiac support therapies such as ECMO.

Keywords

• metformin overdose
• suicide
• lactic acidosis
• extracorporeal membrane oxygenation
• continuous renal replacement therapy