Shadnia Shahin, Barzi Farnaz, Askari Anvar, Hassanian-Moghaddam Hossein, Zamani Nasim, Ebrahimian Kimia
Department of Clinical Toxicology, Loghman Hakim Hospital, Karegar Street, Tehran, Iran.
Curr Drug Saf. 2013 Sep;8(4):278-81. doi: 10.2174/1574210195346398863.
The aim of this study was to evaluate the frequency of metformin-associated lactic acidosis in our metformin-intoxicated patients, the general approach for their management, and determine the frequency of hypoglycemia and outcome in these patients. We also wanted to see if there was a significant difference in the course and outcome of metformin poisoning between our patients and those reported in the literature.
Files of all patients diagnosed with metformin toxicity were retrospectively evaluated. A purposemade questionnaire containing the patients' demographic data, vital signs and lab tests on presentation, time of development of hypoglycemia and metabolic acidosis (if any), treatment modalities performed for the patients and their indications, and the patients' outcomes was filled. The patients were evaluated in total and then assigned into two groups of metformin alone (group 1) and multi-drug toxicity including metformin (group 2) and were compared.
A total of 204 patients were reviewed. Fifty-five (26.9%) were in group 1 and 149 (73.1%) were in group 2. Sixteen and 52 patients in groups 1 and 2 had acidosis. Dialysis was performed in only four patients, all of whom belonged to group 1 (P = 0.005). They were all dialyzed only once. Two patients (1%) died both of whom were in group 2. Groups 1 and 2 were insignificantly different in all characteristics except for their aspartate transaminase and creatine phosphokinase. Almost 23% of the patients in group 1 had experienced hypoglycemia sometime during their course of hospitalization.
Although lactic acidosis is considered to be a serious condition resulting in high mortality and morbidity rates, it seems that our patients can easily and safely be managed with conservative therapies. Most of them do not need aggressive treatments including hemodialysis. Metformin seems to cause hypoglycemia more than what was previously considered.
本研究旨在评估二甲双胍中毒患者中二甲双胍相关乳酸酸中毒的发生率、一般处理方法，并确定这些患者低血糖的发生率及转归。我们还想了解我们的患者与文献报道的患者在二甲双胍中毒的病程和转归方面是否存在显著差异。
对所有诊断为二甲双胍中毒的患者病历进行回顾性评估。填写一份特制问卷，内容包括患者的人口统计学数据、就诊时的生命体征和实验室检查结果、低血糖和代谢性酸中毒（如有）的发生时间、对患者实施的治疗方式及其适应证，以及患者的转归。对患者进行总体评估，然后分为单纯二甲双胍组（第1组）和包括二甲双胍在内的多药中毒组（第2组）并进行比较。
共审查了204例患者。第1组55例（26.9%），第2组149例（73.1%）。第1组和第2组分别有16例和52例患者发生酸中毒。仅4例患者进行了透析，均属于第1组（P = 0.005）。他们均仅接受了一次透析。2例患者（1%）死亡，均在第2组。第1组和第2组除天冬氨酸转氨酶和肌酸磷酸激酶外，所有特征均无显著差异。第1组近23%的患者在住院期间曾发生过低血糖。
尽管乳酸酸中毒被认为是一种导致高死亡率和发病率的严重疾病，但似乎我们的患者通过保守治疗即可轻松、安全地得到处理。他们中的大多数不需要包括血液透析在内的积极治疗。二甲双胍导致低血糖的情况似乎比之前认为的更为常见。
