Fatal metformin overdose presenting with refractory hypotension: Postmortem examination

Abstract

Metformin is a biguanide oral hypoglycemic agent. A 57‑year‑old male ingested over 100 g of metformin in a suicidal attempt. He presented with mild decreased level of consciousness, severe hypotension, and metabolic acidosis. Conventional measures including gastrointestinal decontamination, crystalloid fluid, norepinephrine infusion, and sodium bicarbonate therapy were performed. Despite aggressive intervention, the patient died. Severe hypotension and metabolic acidosis were the life‑threatening presentation of severe metformin poisoning, which led to fatality. Other interventions such as hemodialysis may be lifesaving