Hendrikx Jeroen J M A, Lagas Jurjen S, Daling Ratana, Hooijberg Jan Hendrik, Schellens Jan H M, Beijnen Jos H, Brandjes Desiderius P M, Huitema Alwin D R
Department of Pharmacy & Pharmacology, Slotervaart Hospital, Amsterdam, The Netherlands.
Basic Clin Pharmacol Toxicol. 2014 Nov;115(5):472-5. doi: 10.1111/bcpt.12251. Epub 2014 Apr 28.
An intoxication with drugs, ethanol or cleaning solvents may cause a complex clinical scenario if multiple agents have been ingested simultaneously. The situation can become even more complex in patients with (multiple) co-morbidities. A 59-year-old man with type 2 diabetes mellitus (without treatment two weeks before the intoxication) intentionally ingested a substantial amount of ethanol along with ~750 mL of laminate floor cleaner containing citric acid. The patient was admitted with severe metabolic acidosis (both ketoacidosis and lactic acidosis, with serum lactate levels of 22 mM). He was treated with sodium bicarbonate, insulin and thiamine after which he recovered within two days. Diabetic ketoacidosis and lactic acidosis aggravated due to ethanol intoxication, thiamine deficiency and citrate. The high lactate levels were explained by excessive lactate formation caused by the combination of untreated diabetes mellitus, thiamine deficiency and ethanol abuse. Metabolic acidosis in diabetes is multi-factorial, and the clinical situation may be further complicated, when ingestion of ethanol and toxic agents are involved. Here, we reported a patient in whom diabetic ketoacidosis was accompanied by severe lactic acidosis as a result of citric acid and mainly ethanol ingestion and a possible thiamine deficiency. In the presence of lactic acidosis in diabetic ketoacidosis, physicians need to consider thiamine deficiency and ingestion of ethanol or other toxins.
如果同时摄入多种药物、乙醇或清洁溶剂，中毒可能会导致复杂的临床情况。对于患有（多种）合并症的患者，情况可能会变得更加复杂。一名59岁的2型糖尿病男性患者（中毒前两周未接受治疗）故意摄入了大量乙醇以及约750毫升含柠檬酸的强化木地板清洁剂。该患者因严重代谢性酸中毒（酮症酸中毒和乳酸酸中毒，血清乳酸水平为22 mM）入院。他接受了碳酸氢钠、胰岛素和硫胺素治疗，两天内康复。乙醇中毒、硫胺素缺乏和柠檬酸盐导致糖尿病酮症酸中毒和乳酸酸中毒加重。高乳酸水平是由未治疗的糖尿病、硫胺素缺乏和乙醇滥用共同作用导致的乳酸过度生成所致。糖尿病中的代谢性酸中毒是多因素的，当涉及乙醇和有毒物质摄入时，临床情况可能会进一步复杂化。在此，我们报告了一名患者，其糖尿病酮症酸中毒伴有严重乳酸酸中毒，原因是柠檬酸摄入，主要是乙醇摄入以及可能的硫胺素缺乏。在糖尿病酮症酸中毒合并乳酸酸中毒的情况下，医生需要考虑硫胺素缺乏以及乙醇或其他毒素的摄入。
