与二甲双胍相关的乳酸性酸中毒。
Lactic acidemia associated with metformin.
作者信息
Khan Jamshed K, Pallaki Muralidhar, Tolbert Sandra R, Hornick Thomas R
机构信息
Geriatric Medicine, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, OH, USA.
出版信息
Ann Pharmacother. 2003 Jan;37(1):66-9. doi: 10.1345/aph.1C183.
OBJECTIVE
To report 2 cases of lactic acidemia associated with the use of metformin in patients with normal renal function.
CASE SUMMARY
An 82-year-old African American man and a 76-year-old white man developed an elevated serum lactic acid concentration a few weeks after initiation of metformin therapy for type 2 diabetes. After the patients discontinued metformin, the serum lactic acid concentration normalized in both cases. An objective causality assessment revealed that the adverse drug event was probably related to the use of metformin.
DISCUSSION
Metformin interferes with the production and elimination of lactic acid by a variety of mechanisms that are not well understood. Few systematic data are available on changes in plasma lactic acid concentrations in patients with type 2 diabetes and normal renal function. Clinical significance of a high serum lactic acid concentration needs clarification.
CONCLUSIONS
Metformin therapy can be associated with subclinical elevation of lactic acid concentration in the absence of renal insufficiency or other contraindications to using this agent in patients with type 2 diabetes. Periodic monitoring of basic metabolic panels may prevent this potentially serious complication of metformin therapy.
目的
报告2例肾功能正常的患者使用二甲双胍后发生乳酸性血症的病例。
病例摘要
一名82岁非裔美国男性和一名76岁白人男性在开始使用二甲双胍治疗2型糖尿病几周后，血清乳酸浓度升高。患者停用二甲双胍后，两例患者的血清乳酸浓度均恢复正常。客观因果关系评估显示，该药物不良事件可能与二甲双胍的使用有关。
讨论
二甲双胍通过多种尚未完全明确的机制干扰乳酸的生成和清除。关于2型糖尿病且肾功能正常的患者血浆乳酸浓度变化的系统性数据很少。高血清乳酸浓度的临床意义需要阐明。
结论
在2型糖尿病患者中，若无肾功能不全或其他使用该药物的禁忌证，二甲双胍治疗可能与乳酸浓度的亚临床升高有关。定期监测基本代谢指标可能预防二甲双胍治疗的这种潜在严重并发症。
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