As several highly publicized traffic collisions occurred in 2003 and 2004, the nation began to give more attention to the issue of older drivers. After several older-driver collisions, California, Minnesota, Wisconsin, and Massachusetts examined their license renewal and driver testing policies for both the young and old. We describe these major traffic incidents and discuss their impact on the political, medical, and social forums.

A 29-year-old man with no history of diabetes ingested over 60 grams of metformin in a suicide attempt. He presented to the emergency department with acute renal insufficiency, severe lactic acidosis, and rapidly-progressive hyperglycemia. The patient’s peak serum glucose level of 707 mg/dL is the highest yet reported in a case of metformin toxicity. Treatment included sodium bicarbonate infusion and hemodialysis, but the patient suffered several cardiac arrests with pulseless electrical activity and ultimately expired 25 hours after the ingestion.

[WestJEM. 2008;9:160-164.]