Fatal metformin overdose presenting with refractory hypotension: Postmortem examination

Fatal Metformin Overdose Presenting with Progressive Hyperglycemia

A 29-year-old man with no history of diabetes ingested over 60 grams of metformin in a suicide attempt. He presented to the emergency department with acute renal insufficiency, severe lactic acidosis, and rapidly-progressive hyperglycemia. The patient's peak serum glucose level of 707 mg/dL is the highest yet reported in a case of metformin toxicity. Treatment included sodium bicarbonate infusi...

Fatal digoxin overdose.

Overdosage with cardiac glycosides is well documented, but not usually fatal. A case is described in which cardiac arrest in asystole was associated with a serum digoxin level of 50-4 microgram/1, the highest concentration yet reported after oral administration.

Postmortem Examination

Regardless of the suspected cause of death, a medical examiner or coroner's postmortem examination should always be thorough and comprehensive, for deaths which come under the jurisdiction of this office are often extremely complex, dealing as they do mostly with instances of sudden and unexpected demise. The postmortem examination should be approached with a certain degree of suspicion of ot.h...

Non-Fatal Amlodipine and Insulin Overdose in an Elderly Person

Noncardiogenic Pulmonary Edema after Amlodipine Overdose without Refractory Hypotension and Bradycardia

Amlodipine overdose can be life-threatening when manifesting as noncardiogenic pulmonary edema. Treatment remains challenging. We describe a case of noncardiogenic pulmonary edema without refractory hypotension and bradycardia after ingestion of 500 milligram amlodipine with suicidal intent. Mechanical ventilation, dexamethasone, atrovent HFA (ipratropium), pulmicort inhalation, and antibiotic ...