Successful use of methylene blue for catecholamine‐refractory vasoplegic shock due to metformin intoxication: A case report and literature review
Abstract Background Severe metformin intoxication can lead to lactic acidosis and vasoplegic shock, for which the optimal management strategy remains uncertain, especially in cases of severe circulatory collapse. Case Presentation A 45‐year‐old diabetic woman on metformin therapy presented with impa...
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| Format: | Article |
| Language: | English |
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Wiley
2024-01-01
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| Series: | Acute Medicine & Surgery |
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| Online Access: | https://doi.org/10.1002/ams2.981 |
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| author | Yuji Takahashi Hidehiko Nakano Maiko Motoki Yuji Wakimoto Daisuke Ikechi Yasuaki Koyama Hideki Hashimoto |
| author_facet | Yuji Takahashi Hidehiko Nakano Maiko Motoki Yuji Wakimoto Daisuke Ikechi Yasuaki Koyama Hideki Hashimoto |
| author_sort | Yuji Takahashi |
| collection | DOAJ |
| description | Abstract Background Severe metformin intoxication can lead to lactic acidosis and vasoplegic shock, for which the optimal management strategy remains uncertain, especially in cases of severe circulatory collapse. Case Presentation A 45‐year‐old diabetic woman on metformin therapy presented with impaired consciousness and seizures. She had experienced a cardiac arrest and undergone extracorporeal cardiopulmonary resuscitation. Blood gas analysis showed severe lactic acidosis. A 71‐g metformin packet was found at the patient's home, suggesting an overdose. Despite extracorporeal support and blood purification, severe lactic acidosis and hypotension persisted. Methylene blue was administered 32 h from the onset, which improved her metabolic and circulatory status. We examined her blood sample throughout the case to check the transition of metformin blood concentration. Conclusion Methylene blue may be beneficial for severe metformin toxicity, regardless of the blood concentration of metformin and the time since intoxication. However, further research is needed to establish its optimal use and effectiveness. |
| format | Article |
| id | doaj-art-b7e6d99d88684658abb0277aa3eb8db2 |
| institution | Kabale University |
| issn | 2052-8817 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Acute Medicine & Surgery |
| spelling | doaj-art-b7e6d99d88684658abb0277aa3eb8db22024-12-30T10:18:37ZengWileyAcute Medicine & Surgery2052-88172024-01-01111n/an/a10.1002/ams2.981Successful use of methylene blue for catecholamine‐refractory vasoplegic shock due to metformin intoxication: A case report and literature reviewYuji Takahashi0Hidehiko Nakano1Maiko Motoki2Yuji Wakimoto3Daisuke Ikechi4Yasuaki Koyama5Hideki Hashimoto6Department of Emergency and Critical Care Medicine Hitachi General Hospital Hitachi Ibaraki JapanDepartment of Emergency and Critical Care Medicine Hitachi General Hospital Hitachi Ibaraki JapanDepartment of Emergency and Critical Care Medicine Hitachi General Hospital Hitachi Ibaraki JapanDepartment of Emergency and Critical Care Medicine Hitachi General Hospital Hitachi Ibaraki JapanDepartment of Emergency and Critical Care Medicine Hitachi General Hospital Hitachi Ibaraki JapanDepartment of Emergency and Critical Care Medicine Hitachi General Hospital Hitachi Ibaraki JapanDepartment of Emergency and Critical Care Medicine Hitachi General Hospital Hitachi Ibaraki JapanAbstract Background Severe metformin intoxication can lead to lactic acidosis and vasoplegic shock, for which the optimal management strategy remains uncertain, especially in cases of severe circulatory collapse. Case Presentation A 45‐year‐old diabetic woman on metformin therapy presented with impaired consciousness and seizures. She had experienced a cardiac arrest and undergone extracorporeal cardiopulmonary resuscitation. Blood gas analysis showed severe lactic acidosis. A 71‐g metformin packet was found at the patient's home, suggesting an overdose. Despite extracorporeal support and blood purification, severe lactic acidosis and hypotension persisted. Methylene blue was administered 32 h from the onset, which improved her metabolic and circulatory status. We examined her blood sample throughout the case to check the transition of metformin blood concentration. Conclusion Methylene blue may be beneficial for severe metformin toxicity, regardless of the blood concentration of metformin and the time since intoxication. However, further research is needed to establish its optimal use and effectiveness.https://doi.org/10.1002/ams2.981drug‐related side effects and adverse reactionsmetforminmethylene bluepoisoningvasoplegia |
| spellingShingle | Yuji Takahashi Hidehiko Nakano Maiko Motoki Yuji Wakimoto Daisuke Ikechi Yasuaki Koyama Hideki Hashimoto Successful use of methylene blue for catecholamine‐refractory vasoplegic shock due to metformin intoxication: A case report and literature review Acute Medicine & Surgery drug‐related side effects and adverse reactions metformin methylene blue poisoning vasoplegia |
| title | Successful use of methylene blue for catecholamine‐refractory vasoplegic shock due to metformin intoxication: A case report and literature review |
| title_full | Successful use of methylene blue for catecholamine‐refractory vasoplegic shock due to metformin intoxication: A case report and literature review |
| title_fullStr | Successful use of methylene blue for catecholamine‐refractory vasoplegic shock due to metformin intoxication: A case report and literature review |
| title_full_unstemmed | Successful use of methylene blue for catecholamine‐refractory vasoplegic shock due to metformin intoxication: A case report and literature review |
| title_short | Successful use of methylene blue for catecholamine‐refractory vasoplegic shock due to metformin intoxication: A case report and literature review |
| title_sort | successful use of methylene blue for catecholamine refractory vasoplegic shock due to metformin intoxication a case report and literature review |
| topic | drug‐related side effects and adverse reactions metformin methylene blue poisoning vasoplegia |
| url | https://doi.org/10.1002/ams2.981 |
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