San Francisco Division, California Poison Control System, University of California, San Francisco, CA, USA.
Clin Toxicol (Phila). 2013 Jun;51(5):444-7. doi: 10.3109/15563650.2013.784774. Epub 2013 Apr 1.
Lactic acidosis is a well-recognized consequence of metformin. Hypoglycemia has been reported previously in metformin overdose, but the presence of other co-ingestions (e.g., a sulfonylurea) was not definitively excluded.
A 15-year-old girl ingested 75 g of metformin and 3 g of quetiapine. On examination in the emergency department 2 h later, she was drowsy but had normal vital signs. She developed lactic acidosis, hypotension, and recurrent and severe hypoglycemia (15 mg/dL and 20 mg/dL), requiring boluses of 50%dextrose. The first episode of hypoglycemia occurred approximately 4 h after ingestion. Serum metformin level 2 h after ingestion was 267 mg/L (therapeutic range, 0.465-2.5), and serum insulin was 2 mU/L (normal range, 6-35). Extensive laboratory investigation using high-resolution mass-spectrometry ruled out other possible hypoglycemic agents. She recovered after hemodialysis.
Metformin overdose can cause severe hypoglycemia in the absence of other antidiabetic drugs. Potential mechanisms of metformin-induced hypoglycemia include decreased hepatic glucose production, decreased glucose absorption, and poor oral intake.
乳酸酸中毒是二甲双胍的一种公认后果。此前曾有报道称二甲双胍过量会导致低血糖，但不能明确排除其他共摄入药物（如磺脲类药物）的存在。
一名 15 岁女孩摄入了 75 克二甲双胍和 3 克喹硫平。在摄入后 2 小时的急诊科检查中，她表现为嗜睡，但生命体征正常。她出现乳酸酸中毒、低血压和反复严重低血糖（15mg/dL 和 20mg/dL），需要推注 50%葡萄糖。首次低血糖发作发生在摄入后约 4 小时。摄入后 2 小时的血清二甲双胍水平为 267mg/L（治疗范围为 0.465-2.5），血清胰岛素为 2mU/L（正常范围为 6-35）。使用高分辨率质谱的广泛实验室检查排除了其他可能的低血糖药物。她在血液透析后康复。
二甲双胍过量可导致严重低血糖，而无其他抗糖尿病药物。二甲双胍引起低血糖的潜在机制包括肝葡萄糖生成减少、葡萄糖吸收减少和口服摄入不良。
