Leonaviciute Dovile, Madsen Bo, Schmedes Anne, Buus Niels H, Rasmussen Bodil S
Department of Anaesthesiology and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark.
Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark.
Case Rep Crit Care. 2018 May 8;2018:3868051. doi: 10.1155/2018/3868051. eCollection 2018.
Metformin poisoning is a life-threatening condition with a high mortality rate. We present a patient case of metformin poisoning following intake of 80 g metformin resulting in severe lactate acidosis with a nadir pH of 6.73 and circulatory collapse, successfully treated with addition of prolonged intermittent hemodialysis (HD) to continuous venovenous hemofiltration (CVVH). The patient's pH became normal 48 hours after metformin ingestion during simultaneous CVVH and addition of 22 hours of intermittent HD in the ICU. The highest metformin level was found to be 991 mol/L (therapeutic range 3.9-23.2 mol/L). We conclude that in cases of severe metformin poisoning with circulatory shock and extreme lactic acidosis, the usual CVVH modality might not efficiently clear metformin. Therefore, additional prolonged HD should be considered even in the state of cardiovascular collapse with vasopressor requirement.
二甲双胍中毒是一种危及生命的疾病，死亡率很高。我们报告一例患者，摄入80克二甲双胍后发生二甲双胍中毒，导致严重乳酸酸中毒，最低pH值为6.73，并出现循环衰竭，通过在持续静脉-静脉血液滤过（CVVH）基础上增加延长的间歇性血液透析（HD）成功治疗。在重症监护病房（ICU）同时进行CVVH并增加22小时间歇性HD后，患者在摄入二甲双胍48小时后pH值恢复正常。发现最高二甲双胍水平为991μmol/L（治疗范围为3.9-23.2μmol/L）。我们得出结论，在伴有循环休克和极重度乳酸酸中毒的严重二甲双胍中毒病例中，常规的CVVH模式可能无法有效清除二甲双胍。因此，即使在需要血管升压药维持心血管功能的循环衰竭状态下，也应考虑增加延长的HD治疗。
