Godo Shigeo, Yoshida Yoshitaro, Fujita Motoo, Kudo Daisuke, Nomura Ryosuke, Shimokawa Hiroaki, Kushimoto Shigeki
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan.
Intern Med. 2017;56(4):455-459. doi: 10.2169/internalmedicine.56.7754. Epub 2017 Feb 15.
Biguanides are a drug of choice for the treatment of type 2 diabetes mellitus. Although they can cause lactic acidosis in susceptible patients with predisposing risk factors, the incidence of lactic acidosis is reported to be very low when they are used properly. We herein present a case of biguanide-associated severe lactic acidosis complicated with thiamine deficiency that was provoked without predisposing factors for thiamine deficiency. Diabetic patients taking biguanide may be predisposed to thiamine deficiency, even when there is no evidence of risk factors, and the high-dose administration of thiamine may be essential in the treatment of this otherwise under-recognized disorder.
双胍类药物是治疗2型糖尿病的首选药物。虽然它们可在具有易感风险因素的患者中引起乳酸性酸中毒，但据报道，正确使用时乳酸性酸中毒的发生率非常低。我们在此报告一例双胍类药物相关的严重乳酸性酸中毒合并硫胺素缺乏症的病例，该病例在没有硫胺素缺乏易感因素的情况下发生。服用双胍类药物的糖尿病患者即使没有危险因素的证据，也可能易患硫胺素缺乏症，大剂量补充硫胺素可能是治疗这种否则未被充分认识的疾病的关键。
