AlKhateb B, Alkhateb O, Daaboul B. Metformin abuse and weight loss: A case report. World J Clin Cases 2025; 13(30): 110820 [DOI: 10.12998/wjcc.v13.i30.110820]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ouwais Alkhateb, Department of Internal Medicine, American University of Beirut Medical Center, Beriut 46052, Lebanon
Bisher Daaboul, Department of Gastroenterology, Medical Care Center, Damascus 20872, Syria
Co-first authors: Bader AlKhateb and Ouwais Alkhateb.
Author contributions: AlKhateb B contributed to writing the abstract and discussion; Alkhateb O contributed to writing the case presentation and background; Daaboul B contributed to supervision and was the patient’s primary physician; All authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: All authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: June 16, 2025 Revised: July 6, 2025 Accepted: July 29, 2025 Published online: October 26, 2025 Processing time: 117 Days and 11.5 Hours
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.
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.
