[Voluntary self-poisoning with metformin and antiretroviral therapy drugs].

Metformin is a commonly prescribed oral medication for type 2 diabetes, and while it is generally effective, it can have severe side effects, particularly metformin-associated lactic acidosis (MALA). This condition typically occurs accidentally in patients with renal failure, but a recent case study presents a rare instance of voluntary self-poisoning with metformin, as well as antiretroviral therapy drugs. The patient in question was admitted to the hospital with severe lactic acidosis, characterized by a pH level of 7.19, which is significantly lower than the normal range of 7.38-7.42. Additionally, the patient's lactate levels were elevated at 9.40 mmol/L, far exceeding the normal range of 0.50-2.20 mmol/L. The presence of metformin and antiretroviral therapy drugs in the patient's system was confirmed through the use of advanced laboratory techniques, including high-performance liquid chromatography coupled with diode array detector (HPLC-PDA) and high-performance liquid chromatography with mass spectrometry (HPLC-MS). The metformin dosage was found to be 814 mg/L, which is significantly higher than the therapeutic range of 1-2 mg/L. Unfortunately, the patient's condition continued to deteriorate during hospitalization, with liver dysfunction contributing to an altered lactate elimination and worsening lactic acidosis. Despite therapeutic interventions, the patient's condition proved to be fatal, resulting in death 30 hours after presentation. This rare and unusual case highlights the potential risks associated with metformin and antiretroviral therapy drugs, particularly when taken in excess, and underscores the importance of careful monitoring and management of patients with diabetes and other comorbidities. The combination of metformin and antiretroviral therapy drugs appears to have increased the risk of lactic acidosis and liver failure, emphasizing the need for caution and vigilance in patients taking these medications. Link: https://pubmed.ncbi.nlm.nih.gov/40341113/