[Fatal autointoxication with metformin]. / Een fatale auto-intoxicatie met metformine.

A 39-year-old woman with type-2 diabetes mellitus presented with metabolic acidosis due to an attempted suicide with metformin. Despite treatment with activated charcoal and laxation, she experienced cardiac arrest, which required resuscitation. After transfer to another hospital, she was treated with high-volume continuous venovenous haemofiltration. However, she died due to multiple organ failure. Metformin is the most widely used oral antidiabetic agent in the world and the first-choice treatment for patients with type-2 diabetes mellitus. Metformin overdose can cause lactic acidosis, which usually manifests as abdominal pain, vomiting and diarrhoea. Although rare, metformin-associated lactic acidosis carries a high mortality risk. The treatment of choice is immediate haemodialysis and orally administered activated charcoal. If a patient treated with metformin presents with metabolic acidosis, lactic acidosis due to metformin overdose should be suspected and appropriate treatment should be initiated immediately.

Nonsurgical videolaparoscopy for determination of reproductive status of the Arctic charr.

The efficient commercial production of Arctic charr is hampered by the limited and subtle sexual dimorphism shown by this species. This project examined the feasibility of low-cost videoendoscopy through the genital pore to determine sex, stage of maturity, and safety for 80, randomly selected, anesthetized Arctic charr. The sensitivity and specificity for correct assignment of male sex were 90% and 100%, respectively, among 3 observers in a single-blind design. Sensitivity and specificity for relative sexual maturity in the same fish were 96% and 54%, respectively. The observed mortality rate of 7% at the end of 3 weeks was confounded by the presence of unrelated disease. We conclude that the technique holds promise for application by producers to improve production efficiency.