Metformin abuse and weight loss: A case report

Abstract

BACKGROUND

Metformin is generally safe but can cause lactic acidosis and rarely organ dysfunction during overdose. Misuse for weight loss, especially in undiagnosed eating disorder, is concerning. In stigmatized settings such conditions may go unrecognized This case illustrated severe complications from chronic metformin abuse in a young female with suspected anorexia nervosa, highlighting the need for integrated medical and psychiatric care. To the best of our knowledge, this is only the second case report of multiple organ dysfunction syndrome (MODS) due to metformin toxicity.

CASE SUMMARY

Here, we reported a rare case of MODS involving four organs due to metformin abuse. A 22-year-old female located in Syria with a history suspicious of anorexia nervosa presented with dehydration, diarrhea, and altered consciousness. Labs revealed mixed high and normal anion gap metabolic acidosis from starvation ketosis and bicarbonate loss. She recovered with supportive care but returned 3 months later in shock with severe acidemia, kidney injury, pancreatitis, and liver dysfunction, consistent with MODS. Further history revealed chronic metformin abuse (up to 3000 mg/day) for weight loss. She recovered fully and began cognitive behavioral therapy. This case underscored the dangers of metformin misuse in eating disorders.

CONCLUSION

This case highlighted the potentially life-threatening consequences of surreptitious metformin abuse in the context of an underlying eating disorder. Early recognition, thorough history-taking, and multidisciplinary management, including psychiatric support, are essential for recovery and prevention of recurrence.

Keywords: Metformin; Metformin abuse; Multiple organ dysfunction syndrome; Metformin and weight loss; Anorexia nervosa; Metformin and eating disorder, Lactic acidosis; Case report

Core Tip: This report described a rare case of multiple organ dysfunction syndrome triggered by chronic metformin abuse in a young female with suspected anorexia nervosa. The patient survived two distinct episodes of metformin toxicity with the second requiring mechanical ventilation, vasopressors, and renal replacement therapy. The case highlighted the growing misuse of metformin for weight loss.