Chang Chin-Tung, Chen Yung-Chang, Fang Ji-Tseng, Huang Chiu-Ching
Department of Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
J Nephrol. 2002 Jul-Aug;15(4):398-402.
Lactic acidosis is a widely recognized, though rare, side effect of metformin. This paper describes five patients admitted to Chang Gung Memorial Hospital from 1 September 1998 to 31 May 2001 suffering severe lactic acidosis caused by metformin, and reviews the literature.
Five cases diagnosed as having meftormin-associated lactic acidosis (MALA) were discovered during the study period. Three had normal renal function before the onset of MALA and two had attempted suicide bytaking large amounts of metformin. One patient with end-stage renal disease developed MALA despite regularhemodialysis three times a week. One of the patients who had taken metformin to attempt suicide was not diabetic.
All patients suffered severe metabolic acidosis with a high anion gap and blood lactate level. Four developed profound hypotension, and three of these also suffered acute respiratory failure. Three patients received conventional hemodialysis and two continuous renal replacement therapy. A young non-diabetic female who had taken a large dose of metformin to commit suicide died from multiple organ failure despite aggressive treatment.
Lactic acidosis is a serious reaction to metformin, and hemodialysis (the treatment of choice) should be done urgently to prevent serious complications. MALA should be suspected in patients presenting with wide anion gap metabolic acidosis and high blood lactate, even when they are non-diabetic.
乳酸酸中毒是二甲双胍一种广为人知但较为罕见的副作用。本文描述了1998年9月1日至2001年5月31日期间入住长庚纪念医院的5例因二甲双胍导致严重乳酸酸中毒的患者，并对相关文献进行综述。
在研究期间发现了5例诊断为二甲双胍相关性乳酸酸中毒（MALA）的病例。3例在MALA发作前肾功能正常，2例曾大量服用二甲双胍自杀。1例终末期肾病患者尽管每周规律进行3次血液透析仍发生了MALA。其中1例服用二甲双胍自杀的患者并非糖尿病患者。
所有患者均出现严重的代谢性酸中毒，伴有高阴离子间隙和血乳酸水平升高。4例出现严重低血压，其中3例还伴有急性呼吸衰竭。3例患者接受了常规血液透析，2例接受了连续性肾脏替代治疗。1例年轻非糖尿病女性因大量服用二甲双胍自杀，尽管积极治疗仍死于多器官功能衰竭。
乳酸酸中毒是二甲双胍的一种严重反应，应紧急进行血液透析（首选治疗方法）以预防严重并发症。对于出现宽阴离子间隙代谢性酸中毒和高血乳酸的患者，即使是非糖尿病患者，也应怀疑MALA。
