Nishihama Kota, Maki Kanako, Okano Yuko, Hashimoto Rei, Hotta Yasuhiro, Uemura Mei, Yasuma Taro, Suzuki Toshinari, Hayashi Toyomi, Ishikawa Eiji, Yano Yutaka, Gabazza Esteban C, Ito Masaaki, Takei Yoshiyuki
Department of Diabetes, Metabolism and Endocrinology Mie University Graduate School of Medicine Tsu Japan.
Department of Diabetes and Endocrinology Mie University Hospital Tsu Japan.
Acute Med Surg. 2016 Aug 3;4(1):123-126. doi: 10.1002/ams2.233. eCollection 2017 Jan.
A 64-year-old Japanese woman with diabetes mellitus was admitted for hypoglycemia. Her diabetes had been under good control with glimepiride, voglibose, exenatide, and metformin for a few years. Although overt proteinuria was observed, the serum creatinine values were within normal range during the routine outpatient follow-up. Hypoglycemic attack caused by glimepiride and loss of appetite by urinary tract infection were diagnosed. Then, metformin-associated lactic acidosis with acute renal failure caused by dehydration was detected.
Her condition was improved by continuous veno-venous hemodiafiltration and hemodialysis, known to be useful to remove metformin.
We reported a case of metformin-associated lactic acidosis with hypoglycemia during routine treatment of diabetes that was successfully rescued by early renal replacement therapy.
一名64岁的日本糖尿病女性因低血糖入院。她的糖尿病在使用格列美脲、伏格列波糖、艾塞那肽和二甲双胍治疗数年期间一直控制良好。尽管观察到明显蛋白尿，但在常规门诊随访期间血清肌酐值在正常范围内。诊断为格列美脲引起的低血糖发作和尿路感染导致的食欲不振。随后，检测到二甲双胍相关乳酸酸中毒伴因脱水导致的急性肾衰竭。
通过持续静脉 - 静脉血液透析滤过和血液透析，她的病情得到改善，已知这些方法对清除二甲双胍有效。
我们报告了一例在糖尿病常规治疗期间发生的二甲双胍相关乳酸酸中毒伴低血糖病例，该病例通过早期肾脏替代治疗成功获救。
