@article{ref1,
title="Metformin intoxication: Vasopressin's key role in the management of severe lactic acidosis",
journal="American journal of emergency medicine",
year="2018",
author="Galiero, Francesca and Consani, Giovanni and Biancofiore, Gianni and Ruschi, Stefano and Forfori, Francesco",
volume="36",
number="2",
pages="341.e5-341.e6",
abstract="Vasopressin is a potent vasopressor used for improving organ perfusion during cardiac arrest, septic and catecholamine-resistant shock; with reference to this, it is useful for the treatment of vasoplegic shock because, restoring organ perfusion pressure by contraction of vascular smooth muscle through a non-catecholamine receptor pathway, it can be employed when catecholamines are ineffective. A 49-yr-old woman was admitted to the Emergency Department after having intentionally taken 95.2g of metformin, 1.6g of pioglitazone and 40 UI of insulin glargine in a suicide attempt. Despite fluid resuscitation, CVVHDF (continuous veno-venous hemodiafiltration) treatment, norepinephrine and epinephrine infusion, she developed a severe lactic acidosis and a catecholamines-refractive vasodilatory shock. Only the vasopressin infusion, in association with catecholamines, gradually stabilized the patient's hemodynamic status.<p /><p>Language: en</p>",
language="en",
issn="0735-6757",
doi="10.1016/j.ajem.2017.10.057",
url="http://dx.doi.org/10.1016/j.ajem.2017.10.057"
}