Abstract Methylene blue is an atypical vasopressor that is often considered a salvage treatment in refractory septic shock and vasoplegic syndromes. There are, however, case reports of methylene blue having particular efficacy in specific etiologies of shock, such as vasoplegic shock due to metformin-overdose. Presented here is a case of refractory shock due to metformin overdose that corrected rapidly after the administration methylene blue as an adjunctive agent to hemodialysis and supportive care. A 57 year old male presented to the emergency department after ingesting an unknown amount of metformin two days ago which resulted in severe lactic acidosis, refractory shock, and extreme agitation necessitating intubation complicated by PEA arrest. Despite over 12 hours of continuous hemodialysis, his vasopressor need continued to rise; he was on infusions of epinephrine, norepinephrine, phenylephrine, vasopressin, and bicarbonate as well as hydrocortisone injections. He was then given 2mg/kg of methylene blue over twenty minutes followed by an additional infusion of 200mg over twelve hours. After receiving the first dose of methylene blue, he was weaned off of epinephrine within one hour, phenylephrine within three hours, bicarbonate within six hours, and was off of vasopressor support entirely and extubated in less than twenty four hours. This case, among others, suggests a significant therapeutic role for methylene blue in vasoplegic shock mediated by metformin toxicity. While trials are needed for formal investigation, the favorable risk profile and relatively inexpensive cost of methylene blue support consideration for early adjunctive methylene blue administration in refractory shock due to metformin overdose. This abstract is funded by: None
Hassman et al. (Fri,) studied this question.