{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T02:42:06Z","timestamp":1751251326709,"version":"3.40.4"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Metformin (MTF) is a widely used oral antidiabetic medication. Regardless the reason, high doses of MTF cause lactic acidosis as a result of its effects on mitochondrial ATP production and no-mediated vascular smooth muscle relaxation. Metformin-associated lactic acidosis can be life-threatening despite all treatments. Methylene blue (MB) has the potential to reverse the toxic effects of MTF through its effects on both the mitochondrial respiratory chain and nitric oxide production. The use of MB in MTF intoxication has only been reported in a limited number of cases. Herein, we present a 16-year-old female patient who attempted suicide by ingesting high doses of MTF. Supportive treatments, such as vasopressor, inotropic treatments, and sodium bicarbonate, were started in the patient who developed fluid-resistant hypotension after pediatric intensive care unit admission. Because of rising lactate levels, Continuous renal replacement therapy (CRRT) was started immediately. Despite all treatments, hypotension and hyperlactatemia persisted; MB was given as a rescue therapy. Noticeable hemodynamic improvement was observed within 30 minutes of initiating MB infusion, allowing a gradual decrease in the doses of inotropic infusions within the first hour of therapy. Patient's cardiovascular support was discontinued on the second day, and she was discharged on the fifth day. We speculate that, considering the mechanisms of MTF toxicity and the mechanisms of action of MB, it is suggested that early administration of MB, not only as a rescue treatment but as the initial approach to MTF poisoning in combination with other treatments, may result in improved outcomes.<\/jats:p>","DOI":"10.1097\/pec.0000000000003152","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T02:00:06Z","timestamp":1710295206000},"page":"818-821","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Methylene Blue in Metformin Intoxication"],"prefix":"10.1097","volume":"40","author":[{"given":"Banu","family":"Katlan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2024,3,13]]},"reference":[{"key":"bib1-20250504","doi-asserted-by":"crossref","first-page":"1926","DOI":"10.1001\/jama.2019.3805","article-title":"Metformin in 2019","volume":"321","year":"2019","journal-title":"JAMA"},{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"496","DOI":"10.2337\/diabetes.55.02.06.db05-1064","article-title":"Activation of the AMP-activated kinase by antidiabetes drug metformin stimulates nitric oxide synthesis in vivo by promoting the association of heat shock protein 90 and endothelial nitric oxide synthase","volume":"55","year":"2006","journal-title":"Diabetes"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s13181-019-00755-6","article-title":"Do patients die with or from metformin-associated lactic acidosis (MALA)? 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