'Massive' metformin overdose.

Massive metformin overdose can cause metabolic acidosis with hyperlactatemia. A 55-year-old woman presented 5 h after multidrug overdose, including 132 g extended-release metformin. Continuous venovenous haemodiafiltration (CVVHDF) and noradrenaline were commenced due to metabolic acidosis (pH 7.

Does attending general practice prior to the emergency department change patient outcomes? A descriptive, observational study of one central London general practice.

Background: The challenge of keeping Emergency Department (ED) attendances down continues and timely access to general practice (GP) is often portrayed as a potential solution.

Setting: One London general practice (registered population = 4900).

Question: Does seeing a GP before attending the ED affect the outcome of a patient's ED care?

Methods: Routine clinical data were extracted using SystmOne primary care computer system for all registered patients with an ED attendance between 1 October 2014 and 31 September 2015.