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Metformin Poisoning Management

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Anion gap usmle - anion gap metabolic acidosis normal anion gap metabolic acidosis

Metabolic Acidosis In A Patient With Metformin Overdose

We report a rare fatal case of acute metformin overdose in a 19-year-old woman. A 19-year-old woman presented to a district-level emergency centre (EC) 1 hour after an intentional 'unquantifiable' metformin overdose. Clinical examination at that time was unremarkable except for a respiratory rate (RR) of 28 breaths per minute (bpm). No specific toxidrome was identified. In the EC, 6 hours post metformin ingestion, she appeared restless and complained of severe abdominal pain for which ranitidine, hyoscine butylbromide and lorazepam were administered orally. The patient was observed overnight in the EC. Eighteen hours post ingestion her tachypnoea worsened to 40 bpm and she developed hypoglycaemia with a finger prick blood glucose reading of 1.8 mmol/L. Venous blood gas findings taken at room temperature at this time are shown in Table 1 . Calculation of the anion gap was not possible because lactate and chloride values were not readily available. Based on the patient history and biochemical findings, a diagnosis of metabolic acidosis secondary to acute metformin overdose was made. Infusions of 5% dextrose w/v and 0.5% sodium bicarbonate were initiated separately, and the patient w Continue reading >>

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  1. Rcroix

    Hello everyone.
    I have been on the 2:5 for about 6 months and lost about 10kg (over 20lbs) So thank you Dr Mosley!
    A lot of the reviews of the fasting lifesyle seem to suggest that it is just a way to reduce average weekly calories, but I’m sure most of you think there is more going on than simple calorie reduction.
    During the last 10 days I didn’t fast as I was on holiday traveling and found it difficult. Amazingly I did not gain any weight. This has happend on two occasions during the last 6 months.
    I think the fasting days are forcing the body to relearn how to burn fat. I’m a bit confused about the correct scientific terms for this ‘lypolysis’ is I believe the breackdown of fats (into amino acids) and ketosis the burning of
    fat as fuel.
    What ever the terminology it seems like the fasting days teach the body a long forgotten trick of switching from available glucose derived from what we just ate, to reserves stored as fat.
    I suggest that this trait applies to non fast days too, hence the lack of weigh gain during holidays.
    I used to do a bit of distance running and am quite familiar with the concept of ‘hitting the wall’. This is when a runner runs out of glucose and has to switch to fat burning (around the 18mile mark). Often that process is difficult, I have had to sit on the ground for about 3 minutes until my legs felt like they would work again.
    I’m not running now so I can’t try a quick marathon to see if the diet has helped with the switch.
    I welcome your thoughts.
    Good luck
    Martin.
    Perhaps Dr Mosely could weigh in on this with some scientific evidence.

  2. zec4peach

    I love science and this is why I love the 5.2 as it makes so much sense.
    Your body will go into ketosis when fasting for a short time, this is probably why some people get headaches. It will also make you very thirsty and wee a lot as your body tries to flush out the by products from fat metabolism. This is a common symptom of type 1 diabetes but obviously they go into a severe more ketoacidosis due to prolonged lack of insulin and metabolism of glucose and start burning muscle for fuel.
    It’s quite complicated stuff but if you google fasting ketosis there’s loads of interesting info online. Michaels book was lacking in any science stuff which is a shame as I think people are interested.
    I know that athletes or very fit people are more efficient at burning fat as they are used to it so yes I think the 5.2 does reset the metabolism in a similar way.
    I have managed to this this after years of cycling and find I can ride for a few hours on an empty stomach. Always need coffee though !!!
    Z

  3. Nika

    Hey Martin!
    I’m also very interested in ketosis. I tried it out a few weeks ago and didn’t eat any carbs for 1,5 week. I lost quite some weight, but felt like I couldn’t sustain it – I started feeling really weak, dizzy, couldn’t walk straight some days and all in all didn’t get the energy boosts some people boast about.
    So now I just cut carbs on my fast days and allow myself fruit and yoghurt on normal days – still prefer not to eat rice, noodles, bread and potatoes though. Sometimes a baked good or chocolate pudding as a treat, but not regularly. I do think this really contributes to my quicker than average weightloss (7kg in 3 weeks, of which most during that first 1,5 week).
    I’ve also started working out fasted. I do this after work before my only meal of the day, so after fasting for over 20 hours. I do HIIT (Insanity), which combines cardio and strength through bodyweight exercises. So far my results have been worse than when I did the program before when eating regularly, but I’m waiting to see how it goes in two weeks when I do my second fit test. My body is most likely also learning how to switch to burning fat efficiently.
    What you said about going on a holiday, this reminded me of the “carb loaders” I know. They basically cut carbs during the week, then they “carbload” on Saturday – eating everything from pizza to ribs to whatever they want. They say that it doesn’t cause them to gain weight, because the body is still in fat burning mode and the glucose from the carbs goes straight to the muscles, giving the muscles the strength to keep working out through the next week. Hence carb ‘loading’. These people are basically in ketosis 3 days a week (it usually takes the body about 3 days to go into full ketosis).
    These are all bodybuilder types though, who do mostly strength training so it doesn’t really sound like a great idea for me. I wanna be lean, not buff.
    Anyway, long post – gonna head over to the next one
    Annika

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Poisoning - Hypoglycaemic Agent - Kids Health Wa (pmh Ed Guidelines)

Oral hypoglycaemic agents are used for type II diabetes mellitus (non-insulin dependent diabetes) Sulfonylurea agents increase pancreatic insulin secretion and are the most important cause of hypoglycaemic toxicity Modified-release preparations may delay onset of symptoms for up to 8-18 hours Metformin is a biguanide agent that acts by decreasing carbohydrate absorption from the gut, increasing glucose uptake in peripheral tissues in the presence of insulin, and reducing hepatic gluconeogenesis The thiazolidinedione agents act at a nuclear receptor to improve insulin sensitivity in adipose tissues, skeletal muscles and the liver. Minimal information is available regarding overdose. The sulfonylurea agents may cause prolonged and profound life-threatening hypoglycaemia after accidental paediatric ingestion or deliberate self-poisoning Large overdoses may require treatment for several days A single tablet in a toddler has the potential to cause life-threatening hypoglycaemia. The onset of hypoglycaemia may be delayed up to 18 hours after ingestion. Admission for a minimum of 12- 24 hours is indicated for blood glucose monitoring. Discharge from hospital should only occur in the dayl Continue reading >>

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Popular Questions

  1. chelseyRN

    This is my 13th day on the ketogenic diet. I bought ketone test strips to test my urine. I've been testing a few times a day and been in the low range. This morning I've tested twice and it says "Large" and correlates with the "8 mmol/L" color on the test strips. I've been "high fat, moderate whole foods carbs" for months, if not longer. I'm not diabetic but have a glucometer to test for blood sugar spikes to know what foods to avoid. My blood sugars have been 60-90s consistently. Is there any concern about spilling too many ketones? Educate me please!!

  2. Jason_v

    Just due to the nature of the presence of the 3 different versions of circulating ketones, some will always spill over to the urine. how detectable they are will depend on your hydration level more than anything else. So no there is no concern, which is good because you can't do anything about it anyway. If you are producing ketones, some will show up in the urine:period. if you are hyper hydrated you won't see many, if you are dehydrated you will see dark purple. Exercise tends to reduce the amount of ketones in the urine, in my experience. There is a falsehood that circulates that your body "learns" to use ketones more effectively thus "spilling less" into the urine but that's not technically correct. Although the use of ketones by different tissues can be up regulated (made more efficient depending on demand) there will always be some in the urine if you are producing them at all.

  3. ketohealthclub

    I'd love to read the data explaining that. Do you have any links? I've definitely read the opposite: that over time your body wastes fewer ketones, which renders the ketostix pretty useless after a few weeks.

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Extracorporeal Treatment For Metformin Poisoning: Systematic Review And Recommendations From The Extracorporeal Treatments In Poisoning Workgroup

Background:Metformin toxicity, a challenging clinical entity, is associated with a mortality of 30%. The role of extracorporeal treatments such as hemodialysis is poorly defined at present. Here, the Extracorporeal Treatments In Poisoning workgroup, comprising international experts representing diverse professions, presents its systematic review and clinical recommendations for extracorporeal treatment in metformin poisoning. Methods:A systematic literature search was performed, data extracted, findings summarized, and structured voting statements developed. A two-round modified Delphi method was used to achieve consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Anonymized votes and opinions were compiled and discussed. A second vote determined the final recommendations. Results:One hundred seventy-five articles were identified, including 63 deaths: one observational study, 160 case reports or series, 11 studies of descriptive cohorts, and three pharmacokinetic studies in end-stage renal disease, yielding a very low quality of evidence for all recommendations. The workgroup concluded that metformin is moderately dialyzable (level of evide Continue reading >>

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  1. berra

    So I've been getting told that my breath smells like corn. I have read that when your body is in keto sis your breath will have a sweet smell to it.
    I restrict carbs to max 50-55g/day, regardless if its a training day or not (train 4 days/week and basketball 1 day/week).
    Just wondering if anyone else is experiencing this?

  2. AMonkey

    I think your breath is meant to smell more like vinegar, since one of the by products of ketosis is acetic acid, which is vinegar. Could be totally wrong though.

  3. berra

    Originally posted by AMonkey
    I think your breath is meant to smell more like vinegar, since one of the by products of ketosis is acetic acid, which is vinegar. Could be totally wrong though. Thanks for that. Im basing the 'corn-like' scent on what i keep getting told by an 11 year old! I may need to ask an adult

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