Hourdebaigt-Larrusse P, Israel D, Juillet Y, Couzinier J P, Degusseau B, Soulie J, Perles C, Grivaux M
Sem Hop. 1979;55(39-40):1806-10.
Sixteen cases of lactic acidosis are reported: 7 phenformin treated diabetes, 5 cardiovascular diseases (2 myocardial infractions, 2 pulmonary embolisms, 1 heart failure). In 2 patients no etiology was found. Concomittant renal failure or liver diseases were found in respectively 9 and 4 cases. Patients presented the usual criteria of lactic acidosis: clinical, polypnea, severe hypotension (9/16), peripheral symptoms of shock (12/16), hypothermia (9/16), abdominal pain (9/16): biologically, acidosis (pH = 6,99 +/- 0,01, HCO3- = 5,9 +/- 1,5 mmol), hyperlactatemia (14,1 +/- 3,6 mmol/l) with hig lactate/pyruvate ratio (105 +/- 73), and anion gap (24,3 +/- 4,2 mmol/l). Sodium bicarbonate infusion was performed in all cases (2,5 to 42 mmol/kg). Few cases required volhemic expansion or furosemid induced diuresis. One patient was treated with extrarenal dialysis. 13 patients were alkalinised with less than 185% of estimated deficit measured from alkalin reserve: 12 died. 3 patients received 185% more than this deficit, associated with furosemid (1,8 to 12,5 mg/kg): only one patient died ten days after by casual disease, with lactatemia of 3,2 mmol/l. In spite of the small number of patients, these findings suggest that an early and massive alkalinisation, with large doses of furosemid, can improve the severe lactic acidosis prognosis.
报告了16例乳酸酸中毒病例：7例为苯乙双胍治疗的糖尿病患者，5例患有心血管疾病（2例心肌梗死、2例肺栓塞、1例心力衰竭）。2例患者未发现病因。分别有9例和4例患者伴有肾衰竭或肝病。患者表现出乳酸酸中毒的常见标准：临床方面，有呼吸急促、严重低血压（9/16）、休克的外周症状（12/16）、体温过低（9/16）、腹痛（9/16）；生物学方面，有酸中毒（pH = 6.99±0.01，HCO3- = 5.9±1.5 mmol）、高乳酸血症（14.1±3.6 mmol/l），乳酸/丙酮酸比值高（105±73），以及阴离子间隙（24.3±4.2 mmol/l）。所有病例均进行了碳酸氢钠输注（2.5至42 mmol/kg）。少数病例需要扩容或使用速尿诱导利尿。1例患者接受了肾外透析。13例患者用低于根据碱储备量估计的碱缺失量的185%进行碱化：12例死亡。3例患者接受的碱量比该缺失量多185%，并联合使用速尿（1.8至12.5 mg/kg）：仅1例患者在十天后因偶然疾病死亡，当时乳酸血症为3.2 mmol/l。尽管患者数量较少，但这些发现表明，早期大量碱化并使用大剂量速尿可改善严重乳酸酸中毒的预后。
