Oral Antidiabetic Drug Intoxication in a Toddler; Prophylactic Treatment or Follow Up?

Case Report

J Pediatri Endocrinol. 2016; 1(1): 1001.

Oral Antidiabetic Drug Intoxication in a Toddler; Prophylactic Treatment or Follow Up?

Odabas¹ Günes S¹*, Dursun ZE² and Törel Ergür A¹

¹Department of Pediatric Endocrinology, Kirikkale University Faculty of Medicine, Turkey

²Department of Pediatrics, Kirikkale University Faculty of Medicine, Turkey

*Corresponding author: Odabasi Günes S, Department of Pediatric Endocrinology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey

Received: October 30, 2015; Accepted: January 18, 2016; Published: January 20, 2016

Abstract

Metformin is an oral anti-diabetic drug,which is used in type 2 diabetes mellitus therapy in adolescents and adults. Main side effects are headache, muscle pain, and gastrointestinal symptoms. Lactic acidosis is a rarely seen fatal side effect in therapeutic or excess doses. Hypoglycemia due to metformin treatment in adult population is indicated to be low but there is limited data in childhood since its usage is limited below 10 years of age. In this paper, consequences and therapeutic approach to high dose metformin intoxication in a 2 year old child is discussed

Keywords: Children; Metformin intoxication

Introduction

Metformin from biguanides group is an oral anti-diabetic drug, which is used in type 2 diabetes mellitus therapy in adolescents and adults. Its direct effect is increasing insulin sensitivity in peripheral tissues. It inhibits hepatic gluconeogenesis and increases the substrates (lactate, pyruvate). Inhibition of hepatic gluconeogenesis is the reason of fatal blood lactate increment with metabolic acidosis in therapeutic doses or excess dose [1,2]. Incidence of lactic acidosis in therapeutic doses has been identified as 3/100000 patient-year. Hypoglycemia is another side effect seen in therapeutic doses or excess dose. It is indicated to be low in the literature, but in a study in adult age group showed that the incidence is in-between 0% and 21% [3]. Due to the fact that metformin usage is limited in children, there isn’t any research in this age group about metformin and its hypoglycemic effect. In this paper, we tried to discuss the consequences and follow up of high dose metformin intoxication in a 2 years old child.

Case

2 years old male child was admitted to Emergency Department (ED) with the history of two metformin 1000 mg tablet (125 mg/kg) intake which belongs to his grandmother 1 hour prior to admission. His mother found him chewing the tablets. His vitals were stable and physical examination was normal. There was not any pill esophagitis. Somatic maturation was appropriate for his age (weight:16 kg, 75- 90 percentile; height:92 cm, 90-97 percentile; BMI:19kg/m², 95 percentile; bone age: 2 years). Complete blood count and biochemistry was normal besides mild AST elevation (46 U/L; normal range: 10- 35 U/L).Gastric lavage was done and active charcoal was given in ED. 1500 cc/m² intravenous (iv) fluid as a maintenance treatment (glucose infusion rate 2,6 mg/kg/min) was started. Although oral feeding every 2-3 hour was maintained, patient’s blood glucose levels were in between 70-80 mg/dl. A blood glucose level above 70 mg/ dl was targeted and glucose infusion rate was increased gradually during follow up (Figure 1). Maximum glucose infusion rate was reached at 16th hour of drug intake (7,1 mg/kg/min). During his follow up;patient’s blood sugar level increased above 100 mg/dl so glucose infusion rate was decreased and stopped 44 hoursafter drug intake. Although there was no acidosis in the blood gas (ph:7,49 pCO2:21,7 HCO3:16,2 BE:-5,3),patient’s blood lactate levels were 2,78 mmol/L (normal range:1,3±0,6 mmol/L) in the blood gas and 22,1 mg/dl (normal range:10-14 mg/dl) in the serum so blood gas and serum lactate levels were followed (Table 1). 48 hours after drug intake, lactate level reached the highest value (3,04 mmol/L; 24,4 mg/ dl).In the subsequent period, lactate level progressively decreased and achieved to normal range at the 120th hour of drug intake.

Citation: Odabasi Günes S, Dursun ZE and Törel Ergür A. Oral Antidiabetic Drug Intoxication in a Toddler; Prophylactic Treatment or Follow Up?. J Pediatri Endocrinol. 2016; 1(1): 1001.