• Am J Emerg Med · Feb 2018

    Case Reports

    Metformin intoxication: Vasopressin's key role in the management of severe lactic acidosis.

    • Francesca Galiero, Giovanni Consani, Gianni Biancofiore, Stefano Ruschi, and Francesco Forfori.
    • Anesthesia, Intensive Care, Reanimation and Pain Medicine School of Medicine, University of Pisa, Pisa, Italy. Electronic address: francescagaliero@gmail.com.
    • Am J Emerg Med. 2018 Feb 1; 36 (2): 341.e5-341.e6.

    AbstractVasopressin is a potent vasopressor used for improving organ perfusion during cardiac arrest, septic and catecholamine-resistant shock; with reference to this, it is useful for the treatment of vasoplegic shock because, restoring organ perfusion pressure by contraction of vascular smooth muscle through a non-catecholamine receptor pathway, it can be employed when catecholamines are ineffective. A 49-yr-old woman was admitted to the Emergency Department after having intentionally taken 95.2g of metformin, 1.6g of pioglitazone and 40 UI of insulin glargine in a suicide attempt. Despite fluid resuscitation, CVVHDF (continuous veno-venous hemodiafiltration) treatment, norepinephrine and epinephrine infusion, she developed a severe lactic acidosis and a catecholamines-refractive vasodilatory shock. Only the vasopressin infusion, in association with catecholamines, gradually stabilized the patient's hemodynamic status.Copyright © 2017 Elsevier Inc. All rights reserved.

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