Ebscohost | 95866464 | Fatal Metformin Overdose: Case Report And Postmortem Biochemistry Contribution.
Fatal metformin overdose: case report and postmortem biochemistry contribution. Source: International Journal of Legal Medicine . May2014, Vol. 128 Issue 3, p483-492. 10p. Author(s): Bonsignore, Alessandro; Pozzi, Fulvia; Fraternali Orcioni, Giulio; Ventura, Francesco; Palmiere, Cristian Abstract: Metformin is an oral antihyperglycemic agent used in the management of type 2 diabetes mellitus. Lactic acidosis from metformin overdose is a rare complication of metformin therapy and occurs infrequently with therapeutic use. Fatal cases, both accidental and intentional, are extremely rare in clinical practice. Metformin is eliminated by the kidneys, and impaired renal function can result in an increased plasma concentration of the drug. In this report, we describe an autopsy case involving a 70-year-old woman suffering from diabetes mellitus and impaired renal function who received metformin treatment. Metformin concentrations in the peripheral blood collected during hospitalization and femoral blood collected during autopsy were 42 and 47.3 g/ml, respectively. Lactic acidosis (29.10 mmol/l) was objectified during hospitalization. Furthermore, postmortem biochemistry allowed ketoacidosis to be diagnosed (blood -hydroxybutyrate, 10,500 mol/l). Death was attributed to lactic acidosis due to metformin intoxication. Increased plasma concentrations of the drug were attributed to severely impaired renal function. The case emphasizes the usefulness of performing exhaustive toxicology and postmortem biochemistry towards the more complete understanding of the pathophysiological mechanisms that may be involved in the death process. Copyright of International Journal of Legal Medicine is the property of Springer Science & Business Media B.V. and its content may not be copied or emaile Continue reading >>
Metformin Overview
Metformin is a prescription medication used to treat type 2 diabetes. Metformin belongs to a group of drugs called biguanides, which work by helping your body respond better to the insulin it makes naturally, decreasing the amount of sugar your liver makes, and decreasing the amount of sugar your intestines absorb. This medication comes in tablet, extended-release tablet, and liquid forms. It is taken up to 3 times daily, depending on which form you are taking. Swallow extended-release tablets whole. Common side effects of metformin include diarrhea, nausea, and upset stomach. Metformin is a prescription medication used to treat type 2 diabetes. This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. Metformin may be found in some form under the following brand names: Serious side effects have been reported including: Lactic Acidosis. In rare cases, metformin can cause a serious side effect called lactic acidosis. This is caused by a buildup of lactic acid in your blood. This build-up can cause serious damage. Lactic acidosis caused by metformin is rare and has occurred mostly in people whose kidneys were not working normally. Lactic acidosis has been reported in about one in 33,000 patients taking metformin over the course of a year. Although rare, if lactic acidosis does occur, it can be fatal in up to half the people who develop it. It is also important for your liver to be working normally when you take metformin. Your liver helps remove lactic acid from your blood. Make sure you tell your doctor before you use metformin if you have kidney or liver problems. You should also stop using metformin and call your doctor right away if you have signs of lactic acidosis. Lactic acidosis is a medical emergency that must be treate Continue reading >>
Metformin
Metformin, marketed under the trade name Glucophage among others, is the first-line medication for the treatment of type 2 diabetes,[4][5] particularly in people who are overweight.[6] It is also used in the treatment of polycystic ovary syndrome.[4] Limited evidence suggests metformin may prevent the cardiovascular disease and cancer complications of diabetes.[7][8] It is not associated with weight gain.[8] It is taken by mouth.[4] Metformin is generally well tolerated.[9] Common side effects include diarrhea, nausea and abdominal pain.[4] It has a low risk of causing low blood sugar.[4] High blood lactic acid level is a concern if the medication is prescribed inappropriately and in overly large doses.[10] It should not be used in those with significant liver disease or kidney problems.[4] While no clear harm comes from use during pregnancy, insulin is generally preferred for gestational diabetes.[4][11] Metformin is in the biguanide class.[4] It works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues.[4] Metformin was discovered in 1922.[12] French physician Jean Sterne began study in humans in the 1950s.[12] It was introduced as a medication in France in 1957 and the United States in 1995.[4][13] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[14] Metformin is believed to be the most widely used medication for diabetes which is taken by mouth.[12] It is available as a generic medication.[4] The wholesale price in the developed world is between 0.21 and 5.55 USD per month as of 2014.[15] In the United States, it costs 5 to 25 USD per month.[4] Medical uses[edit] Metformin is primarily used for type 2 diabetes, but is increasingly be Continue reading >>
Hyperglycemia After Metformin Overdose: A Case Report Sabiha Sahina, D, Cigdem Binayb, Enver Simsekb, Ener Cagri Dinleyicia,
Articles © The authors | Journal compilation © Int J Clin Pediatr and Elmer Press Inc™ | www.theijcp.org This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited 44 Case Report Int J Clin Pediatr. 2016;5(3-4):44-46 ressElmer Kursat Bora Carmanc Abstract We present a case of a 16-year-old non-diabetic girl who ingested over 35 tablets (glucophage Merck 850 mg) of metformin in a sui- cide attempt. She presented to pediatric emergency department with severe lactic acidosis and a progressively increasing serum glucose level. She was in a coma state at the time of admission, Glasgow coma scale was 3/15 and arterial blood pressure was 106/45 mm Hg. Arterial blood gas (ABG) analysis indicated severe metabolic acido- sis (pH 6.7) with high anion gap -30.5, PCO2 13.2, HCO3 3.9, BE -30, lactate 14.54 mmol/L, blood glucose 497, amylase 531 IU/L, and uric acid 10.47 mg/dL. Serum ethanol, acetaminophen and salicylates were measured and found to be undetectable. Electrocardiographic monitoring demonstrated a narrow-complex sinus tachycardia. She was intubated, totally 2,000 cc/m2 fluid and NaHCO3 were given, and insulin infusion 0.1 units/kg was started for blood glucose of 497 mg/dL. But the patient suffered several cardiac arrests with pulse- less electrical activity and ultimately expired 25 h after the ingestion. The patient was transferred to pediatric intensive care unit (PICU) for high-volume continuous veno-venous hemofiltration (CVVH). Despite the supportive care in ICU, she died due to multiple organ failures after 48 h of hospitalization. Keywords: Continue reading >>
Metformin Overdosage
Metformin is a biguanide used to treat type 2 diabetes mellitus and most commonly prescribed oral hypoglycemic agent. Metformin is now also used to treat polycystic ovary syndrome and some malignancies. Despite a good safety profile in a majority of patients with diabetes, the risk of metformin-associated lactic acidosis is genuine when safety guidelines are ignored. Overdoses with metformin are rare, but may result in serious consequences. Case reports and small case series of serious toxicity from metformin overdosage can be found in the medical literature, often with the portrayal of extracorporeal methods for the management of the subsequent severe lactic acidosis. Lactic acidosis can defined as a metabolic acidosis with a blood pH less than 7.35 and a serum lactate more than 2 mmol per liter. It can occur either with therapeutic metformin dosing (which is rare) or in overdose situations. 0.03 cases of lactic acidosis per 1000 patient-years occur within therapeutic dosing, with a majority of these cases among patients that have contraindications to metformin (such as renal insufficiency). In overdose situations, lactic acidosis is seen much more habitually, even though the precise incidence is unclear. Lactic acidosis has been observed in 1.6% of metformin exposures reported to poison control centers; nevertheless, merely 10% of these exposures were due to deliberate overdoses. The incidence of metformin-associated lactic acidosis was 12.8% in a review of poison control center inquiries from Germany. The minimum reported lethal dose was found in a 42 year-old patient who had a blood metformin level of 188 µg/ml (e.g. therapeutic range level is usually between 0.5–2.5 µg/ml). Although the intake of 35 g of metformin has shown to be lethal, the maximum reported to Continue reading >>
Fatal Metformin Overdose: Case Report And Postmortem Biochemistry Contribution
N2 - Metformin is an oral antihyperglycemic agent used in the management of type 2 diabetes mellitus. Lactic acidosis from metformin overdose is a rare complication of metformin therapy and occurs infrequently with therapeutic use. Fatal cases, both accidental and intentional, are extremely rare in clinical practice. Metformin is eliminated by the kidneys, and impaired renal function can result in an increased plasma concentration of the drug. In this report, we describe an autopsy case involving a 70-year-old woman suffering from diabetes mellitus and impaired renal function who received metformin treatment. Metformin concentrations in the peripheral blood collected during hospitalization and femoral blood collected during autopsy were 42 and 47.3 g/ml, respectively. Lactic acidosis (29.10 mmol/l) was objectified during hospitalization. Furthermore, postmortem biochemistry allowed ketoacidosis to be diagnosed (blood -hydroxybutyrate, 10,500 mol/l). Death was attributed to lactic acidosis due to metformin intoxication. Increased plasma concentrations of the drug were attributed to severely impaired renal function. The case emphasizes the usefulness of performing exhaustive toxicology and postmortem biochemistry towards the more complete understanding of the pathophysiological mechanisms that may be involved in the death process. AB - Metformin is an oral antihyperglycemic agent used in the management of type 2 diabetes mellitus. Lactic acidosis from metformin overdose is a rare complication of metformin therapy and occurs infrequently with therapeutic use. Fatal cases, both accidental and intentional, are extremely rare in clinical practice. Metformin is eliminated by the kidneys, and impaired renal function can result in an increased plasma concentration of the drug. Continue reading >>
Metformin Overdose: An Unusual Cause Of Severe Metabolic Acidosis Singh Y, Joshi Sc, Tayal I, Sharma N - Chrismed J Health Res
Metformin is commonly used in the treatment of type 2 diabetes mellitus (DM). Severe lactic acidosis is a rare side effect of this drug. We present a 45-year-old man who deliberately took 30 g of metformin, presumably with suicidal intent. He had not eaten the previous night and presented with altered sensorium and recurrent seizures. He had profound metabolic acidosis at presentation with a pH of 7.06 and a low blood sugar of 44 mgs/dl. The patient was admitted in intensive care unit (ICU) with the suspicion of metformin-associated lactic acidosis. He developed irreversible renal failure, neurological deterioration and anemia. Despite of daily intensive hemodialysis and other supportive measures the patient expired 14 days later. Metformin overdose with renal failure and severe lactic acidosis have high mortality; hence, urgent medical consultation and treatment can be life saving in these patients. Keywords:Anemia, diabetes mellitus, metformin, metabolic acidosis, renal failure Singh Y, Joshi SC, Tayal I, Sharma N. Metformin overdose: An unusual cause of severe metabolic acidosis. CHRISMED J Health Res 2015;2:166-8 Singh Y, Joshi SC, Tayal I, Sharma N. Metformin overdose: An unusual cause of severe metabolic acidosis. CHRISMED J Health Res [serial online] 2015 [cited2018 Apr 1];2:166-8. Available from: Overdose with antidiabetic drugs often requires intensive care treatment and prolonged hospital stays. They can potentially contribute to increase in morbidity and mortality. [1] Metformin is considered a relatively safe oral hypoglycemic agent, although biguanides are well known to cause profound lactic acidosis. [2] However, there are only limited descriptions of metformin overdose in the literature despite its well-recognized potentially fatal side effect. [3] If ta Continue reading >>
Publications
A 14-year-old girl has taken 45 gr ( 0.75 g kg-1 body weight) of metformin in a suicide attempt. The first arterial blood gas showed a marked metobolic acidosis with a high lactat level and subsequently she developed moderate renal failure. The lactic acidosis was successfully treated with early continuous venovenous hemodiafiltration. After 16 h of haemofiltration, the arterial pH steadily increased back to normal levels, and lactic acidosis improved. It is concluded that patients with severe lactic acidosis secondary to metformin overdose should be treated promptly with hemofiltration. Introduction Metformin is a biguanide class drug. Biguanides have been used for many years as oral anti-hyperglycemic agents in the treatment of type II diabetes mellitus. These agents exert their action by increasing cellular insulin sensitivity. Lactic acidosis is a rare but serious adverse effect of metformin, especially in patients with renal failure. Severe lactic acidosis is a recognised and often fatal complication of metformin overdose. Metformin is absorbed relatively rapidly by the intestine and is not metabolised. Abouth 90% of the drug is eleminated by glomerular filtration and tubular secretion with a serum half-life between 1,5 and 5 hours. There are several case reports of metformin overdose in the literature but intoxications with metformine in childhood are rare. In this report we describe a 14 year old healthy girl who devoloped lactic acidosis after ingestion of a metformin overdose. The 14-year-old girl took 45 gr ( 0.75 gr kg-1 body weight) of metformin in a suicide attempt. When she was admitted to the emergency department, she had a Glasgow Coma Scale Score of 13-15. Her body temperature was 36.2 0C. Arteriel pressure was 110/60 mmHg, heart rate 77 beats min-1, re Continue reading >>
Fatal Metformin Intoxication With Markedly Elevated Blood And Liver Concentrations
Fatal Metformin Intoxication with Markedly Elevated Blood and Liver Concentrations California Poison Control System, San Diego Division and Clinical Pharmacy, University of California San Francisco School of Pharmacy, 200 W. Arbor Dr., San Diego, CA 92103 Author to whom correspondence should be addressed. Email: [email protected] . Search for other works by this author on: San Diego County Medical Examiner's OfficeToxicology, 5555 Overland Ave., Suite 1411, San Diego, CA 92123 Search for other works by this author on: San Diego County Medical Examiner's OfficeToxicology, 5555 Overland Ave., Suite 1411, San Diego, CA 92123 Search for other works by this author on: San Diego County Medical Examiner's OfficeToxicology, 5555 Overland Ave., Suite 1411, San Diego, CA 92123 Search for other works by this author on: Journal of Analytical Toxicology, Volume 36, Issue 9, 1 November 2012, Pages 657659, F. Lee Cantrell, Craig L. Nelson, Ray D. Gary, Iain M. McIntyre; Fatal Metformin Intoxication with Markedly Elevated Blood and Liver Concentrations, Journal of Analytical Toxicology, Volume 36, Issue 9, 1 November 2012, Pages 657659, The highest postmortem metformin concentrations are recorded utilizing a sensitive and specific analytical procedure. The peripheral blood metformin concentration was 240 mg/L, the liver concentration was 240 mg/kg and the gastric concentration was 1,700 mg. Additionally, an antemortem blood sample collected shortly after admission revealed a metformin concentration of 210 mg/L. These data, revealing a liver to peripheral blood ratio of 1.0, provide additional support that metformin is not subject to postmortem redistribution. Intentional self-poisonings with metformin can result in death, despite multiple medical interventions. Since being appro Continue reading >>
Metformin-associated Lactic Acidosis Following Intentional Overdose Successfully Treated With Tris-hydroxymethyl Aminomethane And Renal Replacement Therapy
Metformin-Associated Lactic Acidosis following Intentional Overdose Successfully Treated with Tris-Hydroxymethyl Aminomethane and Renal Replacement Therapy Ngan Lam ,1,2 Gurbir Sekhon ,3and Andrew A. House 1,3 1Division of Nephrology, Department of Medicine, Western University, London, ON, Canada N6A 3K7 2London Health Sciences Centre, Kidney Clinical Research Unit, Victoria Hospital, Westminster Tower 800 Commissioners Road East, London, ON, Canada N6A 4G5 3Department of Medicine, Western University, London, ON, Canada N6A 3K7 Received 19 February 2012; Accepted 6 May 2012 Academic Editors: Y.Fujigaki, D.Packham, A.Papagianni, and H.Schiffl Copyright 2012 Ngan Lam et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 43-year-old woman was brought to the hospital with severe metabolic acidosis (pH 6.56, bicarbonate 3 mmol/L, and lactate 18.4 mmol/L) and a serum creatinine of 162 mol/L with a serum potassium of 7.8 mmol/L. A delayed diagnosis of metformin-associated lactic acidosis was made, and she was treated with tris-hydroxymethyl aminomethane (THAM) and renal replacement therapy (RRT). Following a complete recovery, she admitted to ingesting 180 tablets (90 grams) of metformin. Her peak serum metformin concentration was 170 g/mL (therapeutic range 1-2 g/mL). Our case demonstrates an intentional metformin overdose resulting in lactic acidosis in a nondiabetic patient who was successfully treated with THAM and RRT. Metformin is an oral antihyperglycemic agent that is the first-line therapy for noninsulin-dependent diabetes mellitus [ 1 ]. Although the adverse event rate is 2030%, the majority of the Continue reading >>
Metformin Overdose Symptoms And Treatment: What You Should Know
What is Metformin? It is a type of medication called a biguanide, which is used to treat people with type 2 diabetes. Type 2 diabetes is a chronic condition where the body cannot make enough insulin or use it properly. Most people with type 2 diabetes can control their blood sugar levels through regular exercise and healthy diet. In case this does not work, metformin is the first oral diabetes medication that is prescribed to people with type 2 diabetes. It can also be used together with insulin or other diabetes medication to reduce blood glucose levels when it is too high. Controlling high blood sugar is important because it prevents the risk of health complications such as loss of limbs, kidney damage and nerve problems. However, this medicine should not be used to treat type 1 diabetes, a condition where the body produces little or no insulin. This is because metformin works by helping the body respond better to the insulin it already makes. The drug works by reducing the amount of glucose that is produced by your liver and by decreasing insulin that is absorbed by the intestines. This helps to control blood glucose levels in people with type 2 diabetes. Dosage The dosage of metformin depends on your medical condition, response to treatment and kidney function. Do not change your dosage without your doctor’s permission. Your doctor may ask you to start at a lower dose, then gradually increase the dosage to reduce the risk of side effects like stomach upset. This medication is supposed to be taken by mouth, usually 1 to 3 times every day with meals. You should drink plenty of fluids as you take this medication unless directed otherwise by your healthcare provider. Metformin overdose symptoms and treatment Although not common, a metformin overdose can result in seri Continue reading >>
Fatal Metformin Overdose: Case Report And Postmortem Biochemistry Contribution
Abstract Metformin is an oral antihyperglycemic agent used in the management of type 2 diabetes mellitus. Lactic acidosis from metformin overdose is a rare complication of metformin therapy and occurs infrequently with therapeutic use. Fatal cases, both accidental and intentional, are extremely rare in clinical practice. Metformin is eliminated by the kidneys, and impaired renal function can result in an increased plasma concentration of the drug. In this report, we describe an autopsy case involving a 70-year-old woman suffering from diabetes mellitus and impaired renal function who received metformin treatment. Metformin concentrations in the peripheral blood collected during hospitalization and femoral blood collected during autopsy were 42 and 47.3 µg/ml, respectively. Lactic acidosis (29.10 mmol/l) was objectified during hospitalization. Furthermore, postmortem biochemistry allowed ketoacidosis to be diagnosed (blood β-hydroxybutyrate, 10,500 µmol/l). Death was attributed to lactic acidosis due to metformin intoxication. Increased plasma concentrations of the drug were attributed to severely impaired renal function. The case emphasizes the usefulness of performing exhaustive toxicology and postmortem biochemistry towards the more complete understanding of the pathophysiological mechanisms that may be involved in the death process. Discover the world's research 14+ million members 100+ million publications 700k+ research projects Join for free (500 mg at 8 a.m., 1,000 mg at 1 p.m., and 1,000 mg at 7 (500 mg at 8 a.m., 1,000 mg at 1 p.m., and 1,000 mg at 7 Tab l e 1 The results of biochemical antemortem and postmortem investigations Treatment Analyte and blood reference values Urea nitrogen Creatinine Lactate and pH K Na Cl BHB 65–105 mg/dl 5–6.6 % 8.1–17.9 Continue reading >>
Fatal Metformin Overdose Presenting With Progressive Hyperglycemia
Go to: CASE REPORT A 29-year-old man ingested metformin in a suicide attempt. The patient consumed the entire remaining contents of his father’s prescription metformin bottle that originally contained 100 tablets of 850 mg each. The father stated that the bottle had contained at least three-quarters of its original contents, putting the ingested dose between 64 and 85 grams. The patient also consumed ethanol, but denied any other co-ingestants. The parents discovered the overdose around 6:30 a.m., about 5 ½ hours post-ingestion, when the patient began complaining of vomiting, diarrhea, thirst, abdominal pain and bilateral leg pain. Paramedics were called, who found the patient to be agitated with a fingerstick glucose level of 180 mg/dL. The patient had a history of psychosis and depression, including prior suicide attempts by drug ingestion. He was not taking any prescribed medications, having discontinued olanzapine and sertraline several months earlier. The patient had no personal history of diabetes, despite the family history of type II diabetes in his father, who was taking no other anti-diabetic medications than metformin. The patient admitted to daily ethanol and tobacco use, but denied any current or past use of illicit drugs. He had no surgical history or known allergies. Vital signs on arrival to the Emergency Department (ED) were temperature of 35.2°C (rectal), pulse of 113 beats/min, blood pressure of 129/59 mmHg, respirations at 28 breaths/min with 100% saturation via pulse oximetry on room air. The patient was awake and oriented x4, but agitated and slightly confused (GCS=14). Pupils were equal and reactive at 4mm and the oral mucous membranes were dry. Other than tachycardia, the heart and lung exams were unremarkable. The abdomen was mildly tender t Continue reading >>
Metformin Toxicity
Summarized from DellAglio D, Perino L, Kazzi Z et al. Acute metformin overdose: Examining serum pH lactate Levels and metformin concentrations in survivors versus nonsurvivors: A systematic review of the literature. Annals of Emerg Med 2009; 54: 818-23 Metformin, a blood-glucose-lowering drug widely used for treatment of type 2 diabetes, is associated with risk of potentially fatal metabolic (lactic) acidosis. This can occur not only following overdose but also at therapeutic dose in patients with pre-existing renal or liver disease. Results of arterial blood gas analysis reflect metabolic acidosis (reduced blood pH, reduced bicarbonate compensatory increase in pCO2) and increased plasma lactate. Is it possible, as might be intuitively expected, to predict survival in such cases from the severity of the acidosis and/or severity of the hyperlactatemia? That is the question addressed by a recent study. Investigators conducted a systematic review of the literature and identified 22 well-documented case histories of metformin overdose, five of which had a fatal outcome. For each of these cases, investigators abstracted lowest (nadir) pH, highest (peak) plasma lactate concentration and highest (peak) plasma metformin concentration. The median nadir pH among non-survivors was 6.71 (interquartile IQ range 6.71-6.73), this compared with median pH 7.30 (IQ range 7.22-7.36) for survivors. The median peak plasma lactate among non-survivors was 35 mmol/L (IQ range 33.3-39.0) and among survivors 10.8 mmol/L (IQ range 4.2-12.9). Results allowed the conclusion that patients who died following metformin overdose had much lower nadir blood pH and much higher peak plasma lactate concentration than those who survived. No patients with pH > 6.9 and plasma lactate < 25 mmol/L died. Intuiti Continue reading >>
A Pediatric Suicide Attempt By Ingestion Of Metformin, Glimepiride Andsulpiride: A Case Report And Literature Review
Received date: March 01, 2016; Accepted date: July 04, 2016; Published date: July 11, 2016 Citation: Tarek G, Kais G, Ramzi G (2016) A Pediatric Suicide Attempt by Ingestion of Metformin, Glimepiride and Sulpiride: A Case Report and Literature Review. J Clin Toxicol 6:310. doi:10.4172/2161-0495.1000310 Copyright: 2016 Tarek G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. A case of a pediatric patient poisoning after ingestion of metformin , glimepiride and sulpiride, he was presented to the emergency service with symptoms and signs of hypoglycemia. Using a risk assessment based approach, the management of glimepiride and metformin overdose is discussed. Glimepiride overdose invariably results in profound hypoglycemia that requires resuscitation with IV dextrose and the use of octreotide as an antidote. Metformin overdose rarely causes problems. The acute sulpiride poisoning is poorly reported in the medical literature. Pediatric; Suicide attempt; Poisoning; Metformin; Glimepiride; Sulpiride Children suffering from physical, mental or psychological problems are being increasingly evaluated and treated in pediatric clinical [ 1 ]. Pediatric emergency departments frequently admit that a lot of children have attempted to commit suicide. Cases vary depending on both the child's age and some risk factors [ 2 ]. The main profile is a female between 12 and 14 years of age that attempted suicide at home using medication especially benzodiazepines. Among those under 10 years, there is a significant predominance of males using non pharmacological methods [ 3 ]. Understanding how childr Continue reading >>
