Ueda Yu, Wong Christine, Borchers Angela
William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, Davis, CA, 95616.
J Vet Emerg Crit Care (San Antonio). 2018 May;28(3):274-278. doi: 10.1111/vec.12711. Epub 2018 Apr 24.
To report a case of severe lactic acidosis and hypoglycemia due to acute metformin intoxication in a dog.
A female neutered Rat Terrier was presented for an acute onset of seizure-like episodes, weakness, and vomiting approximately 14 hours after ingestion of 198 mg/kg of metformin. The dog was found to be laterally recumbent, paddling, and unresponsive shortly before presentation. On physical exam, the dog was in hypovolemic shock and hypothermic. Blood work revealed severe lactic acidosis and hypoglycemia. The dog was volume resuscitated with intravenous crystalloids and dextrose, followed by a continuous infusion of intravenous fluids and dextrose, as well as administration of isotonic sodium bicarbonate. Repeat blood work showed minimal improvement of the hyperlactatemia for 3 hours despite resolution of hypovolemia and hypoglycemia followed by gradual improvement over the next 9 hours of hospitalization. High performance liquid chromatography/tandem mass spectrometry analysis showed markedly increased plasma metformin concentrations at 3.9 μg/mL. The dog was discharged from the hospital within 24 hours and showed no recurrence of clinical signs one year following discharge.
Metformin-associated lactic acidosis and hypoglycemia is a severe complication in human patients, but has not been reported in veterinary medicine. Aggressive treatment with supportive care including IV fluids and dextrose administration resulted in resolution of the clinical signs in this patient. Metformin toxicosis should be considered in dogs with severe hyperlactatemia and hypoglycemia of unknown etiology.
报告一例犬急性二甲双胍中毒导致严重乳酸酸中毒和低血糖的病例。
一只绝育雌性大鼠梗犬在摄入198mg/kg二甲双胍约14小时后，出现急性癫痫样发作、虚弱和呕吐症状。就诊前不久，该犬侧卧、划水且无反应。体格检查发现该犬处于低血容量性休克和体温过低状态。血液检查显示严重乳酸酸中毒和低血糖。通过静脉输注晶体液和葡萄糖对该犬进行容量复苏，随后持续输注静脉液体和葡萄糖，并给予等渗碳酸氢钠。尽管低血容量和低血糖得到缓解，但重复血液检查显示高乳酸血症在3小时内改善甚微，随后在住院的接下来9小时内逐渐改善。高效液相色谱/串联质谱分析显示血浆二甲双胍浓度显著升高，达3.9μg/mL。该犬在24小时内出院，出院后一年未出现临床症状复发。
二甲双胍相关的乳酸酸中毒和低血糖在人类患者中是一种严重并发症，但在兽医学中尚未见报道。积极的支持治疗，包括静脉输液和给予葡萄糖，使该患者的临床症状得到缓解。对于病因不明的严重高乳酸血症和低血糖的犬，应考虑二甲双胍中毒。
