Clinical Case Database / Category: Patient Management

Metformin intolerance

Publication details

Abigail Perini MBBCh, Salman Danish Jafri MRCP (UK), C L Ch'ng MB BCh BAO , FRCP,
Foundation Years Journal, volume 5, issue 8, p.52 (123Doc Education, London, September 2011)


This case-based discussion looks at an elderly patient with metformin intolerance presenting with nausea and vomiting shortly after eating. It will focus on the key points to look out for when taking a history and performing an examination, potential differential diagnoses and the management of the patient.

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Abigail Perini MBBCh

Foundation Year 2 doctor in Paediatrics at Withybush General Hospital

Salman Danish Jafri MRCP (UK)

ST6 Gastroenterology (Wales Deanery) at Singleton hospital

C L Ch'ng MB BCh BAO , FRCP,

Consultant Gastroenterologist at Singleton Hospital


1. Huw Llewelyn, Hock Aun Ang et al (2009) Chapter 7 'Gastrointestinal symptoms and signs'. Oxford Handbook of Clinical Diagnosis, second edition. Oxford University Press.
2. Steven Edmundowicz (2002) Chapter 2 'Nausea and Vomiting' 20 common problems in gastroenterology. McGraw-Hill Professional.
3. Elliott Joslin, C Ronald Kahn (2005) Chapter 41 'Oral antihyperglycemic agents for type 2 diabetes'. Joslin's diabetes mellitus. Lippincott Williams & Wilkins.
4. Tim Holt, Sudesh Kumar (2009) Chapter 5 'Cardiovascular disease'ABC of diabetes. John Wiley and Sons.
5. Peter McNally (2006) 'Achalasia' GI/liver Secrets, third edition. Elsevier Health Sciences, pp: 19-21.
6. BNF 60, (2010) BMJ Group and RPS Publishing.


Conflict Of Interest

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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.