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Fatal metformin overdose: case report and postmortem biochemistry contribution

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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.

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Acknowledgments

Authors are grateful to the anonymous reviewers, whose constructive and useful comments improved the quality of the article.

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Authors and Affiliations

  1. Department of Legal Medicine, University of Genova, Genoa, Italy

    Alessandro Bonsignore & Francesco Ventura

  2. Department of Public Health, Neurosciences, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy

    Fulvia Pozzi

  3. Department of Pathology, Anatomic Pathology Division, San Martino Hospital, Genoa, Italy

    Giulio Fraternali Orcioni

  4. University Centre of Legal Medicine, Rue du Bugnon 21, 1011, Lausanne, Switzerland

    Cristian Palmiere

Authors
  1. Alessandro Bonsignore
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  2. Fulvia Pozzi
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  3. Giulio Fraternali Orcioni
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  4. Francesco Ventura
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  5. Cristian Palmiere
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Correspondence to Cristian Palmiere.

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Bonsignore, A., Pozzi, F., Fraternali Orcioni, G. et al. Fatal metformin overdose: case report and postmortem biochemistry contribution. Int J Legal Med 128, 483–492 (2014). https://doi.org/10.1007/s00414-013-0927-3

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  • DOI: https://doi.org/10.1007/s00414-013-0927-3

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