Symptoms: Hypoglycemia is not normally a problem encountered with metformin when used alone. In combination therapy with a sulfonylurea or insulin with alcohol, hypoglycemia can occur. In excessive dosage particularly, if there is a possibility of accumulation, lactic acidosis should be suspected. Some of the signs and symptoms suggestive of this condition are nausea, diarrhea, abdominal pain and dyspnea.
Treatment: Intensive supportive therapy is recommended which should be particularly directed at correcting fluid loss and metabolic disturbance. The most effective method to remove lactate and metformin is hemodialysis.