Gonçalves B M, Coelho D
Departamento de Anestesia, Hospital Pedro Hispano, Matosinhos, Portugal.
Servicio de Medicina Intensiva, Hospital Pedro Hispano, Matosinhos, Portugal.
Rev Esp Anestesiol Reanim (Engl Ed). 2019 Nov;66(9):483-486. doi: 10.1016/j.redar.2019.02.009. Epub 2019 Oct 8.
The worldwide prevalence of diabetes mellitus (DM) has risen dramatically over the past two decades and this affects 10-15% of the surgical population. Metformin represents the mainstay of anti-hyperglycaemic therapy for type 2 DM, providing numerous beneficial effects. However, a rare but severe adverse effect is the development of metformin-associated lactic acidosis (MALA) with high mortality rate. We describe a severe case of MALA in the postoperative period that culminated in cardiac arrest. Whereby anaesthetists should be knowledgeable and skilled in the care of patients with diabetes being imperative to focus on preoperative assessment, optimisation, management of pre-existing treatment during the starvation period and identification of patients medicated with metformin at risk of developing MALA.
在过去二十年中，全球糖尿病（DM）患病率急剧上升，这影响了10%至15%的外科手术人群。二甲双胍是2型糖尿病抗高血糖治疗的主要药物，具有多种有益作用。然而，一种罕见但严重的不良反应是发生二甲双胍相关性乳酸酸中毒（MALA），死亡率很高。我们描述了1例术后发生的严重MALA病例，最终导致心脏骤停。麻醉医生必须了解并熟练护理糖尿病患者，重点是术前评估、优化、禁食期现有治疗的管理以及识别有发生MALA风险的服用二甲双胍的患者。
