Metformin Poisoning Management

Share on facebook

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 >>

Share on facebook

Popular Questions

  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
    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 !!!

  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

  4. -> Continue reading
read more
Share on facebook

The world is slowly waking up to the realization that their slowly being poisoned by the commercial sweetener called Splenda, or Sucralose. It's very important to realize that Splenda is NOT sugar, despite it's claims of being "Made from sugar, so it tastes like sugar." Splenda is a chlorinated artificial sweetener just like aspartame and saccharin, and has detrimental health effects to match. A few side effects of Splenda are: Gastrointestinal problems Migraines Seizures Dizziness Blurred vision Allergic reactions Blood sugar increases Weight gain And those aren't even scraping the service. For a more in-depth look at Splenda poisoning have a look at this report by Neil A. G'Nieb here: https://www.amazon.com/Splenda-Poison... Instructions: Listen to on a daily bases in a relaxed or meditative state. Relax and absorb the drone resonance as your mind absorbs the healing affirmations and eradicates your system of the poison.

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 >>

Share on facebook

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.

  4. -> Continue reading
read more
Share on facebook

Hỏi đáp thể hình 134 (1413-1422) Có thể thay chuối bằng đường glucose mua ở tiệm thuốc Tây không? Isotretinoin có ảnh hưởng đến quá trình phát triển cơ không? Nếu để bụng đói khi đi ngủ thì liệu có làm mất cơ hoặc mất cân không? Nếu vai bị yếu thì có nên bổ sung thêm viên dầu cá để bôi trơn khớp không? http://www.thehinhonline.com.vn/baivi... ► Các bạn yêu thích video của THOL xin hãy đăng ký kênh chúng tôi tại: https://www.goo.gl/3DaPPN Theo dõi Thể Hình Online: ♫ http://www.thehinhonline.com.vn ♫ http://www.thol.com.vn ♫ http://www.bbt.com.vn ♫ http://www.tholgymcenter.com.vn ♫ Page Bí kiếp & Event: https://www.facebook.com/bodytechvn ♫ Page Kiến thức: https://www.facebook.com/thehinhonline ♫ FB Duy Nguyễn: https://www.facebook.com/duybbt ♫ Instagram: thehinhonline Twitter: thehinhonline BIGO ID: duynguyenthol ►THOL GYM CENTER◄ Địa chỉ: ♦ BBT Bình Tân: 107-109 đường số 6, phường Bình Trị Đông B, quận Bình Tân, TP Hồ Chí Minh ♦ BBT Hiệp Phú: 10 Trương Văn Thành, phường Hiệp Phú, quận 9, HCM ♦

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 >>

Share on facebook

Popular Questions

  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

  4. -> Continue reading
read more

No more pages to load

Related Articles

  • Insulin Poisoning In Non Diabetics

    Go to: A 27-year-old paramedical personnel without any comorbidities, working as an assistant in the operation theater, was found to be drowsy and drenched in sweat with bradycardia (34 beats/min) and hypotension (80/50 mm of Hg). She was immediately shifted to ICU. She was pale and there was no cyanosis, icterus, clubbing, lymphadenopathy, or any evidence of external injury. Temperature was 99.0°F, with a respiratory rate of 20/min and cold per ...

    insulin Dec 30, 2017
  • Diabetes Type 2 Management

    Evidence-based guidelines for the treatment of type 2 diabetes mellitus focus on three areas: intensive lifestyle intervention that includes at least 150 minutes per week of physical activity, weight loss with an initial goal of 7 percent of baseline weight, and a low-fat, reduced-calorie diet; aggressive management of cardiovascular risk factors (i.e., hypertension, dyslipidemia, and microalbuminuria) with the use of aspirin, statins, and angiot ...

    diabetes Jun 4, 2018
  • What Is Management Of Diabetes?

    Wake up, check your blood sugar. If you don't eat right away, test your blood sugar again before eating. Have a low carb/low sugar breakfast, high in good fats and proteins, which make you feel full longer. Test blood sugar again two hours after eating. Eat a snack with no more than 15 carbs about 3 hours after breakfast. Test blood sugar before lunch. Eat - stay within about 30 carbs for meal. (Or whatever doctor recommends for you.) Test blood ...

    diabetes Jan 5, 2018
  • Metformin Poisoning Management

    Pharmacology and Toxicology: Treatment of Poisons - Metformin Intoxication Pharmacology and Toxicology: Treatment of Poisons - Metformin Intoxication Does this patient have metformin intoxication? Since its introduction to the US market in 1995, the biguinide, metformin has become one of the most prescribed oral hypoglycemics. It is now considered the first line agent to treat type 2 diabetes. Because of its similarity to the drug another biguin ...

    ketosis Apr 24, 2018
  • Insulin Poisoning Symptoms

    Case Study S. P. was a nurse who had a long history of depression. She had stopped her medication several months ago since her life had stabilized. However, with the discovery of her husband having an affair, a setback at work, and the terminal illness of her mother, she soon began to have feelings of unworthiness and hopelessness. She was working for a home health agency and was involved in the care of an elderly woman who had a heart condition ...

    insulin Dec 30, 2017
  • Metformin Vs Insulin In The Management Of Gestational Diabetes

    Metformin vs insulin in the management of gestational diabetes: A systematic review and meta-analysis To evaluate the effectiveness of metformin compared with insulin in achieving glycemic control and investigate the maternal and neonatal outcomes in gestational diabetes mellitus. We searched four electronic databases from inception through December 2012. Terms for Gestational diabetes/gestational diabetes mellitus/diabetes pregnancy AND/OR Metf ...

    insulin Apr 2, 2018

Popular Articles

More in ketosis