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二甲双胍所致乳酸性酸中毒：时间问题

Metformin-Induced Lactic Acidosis: A Question of Time.

作者信息

Bellefroid Céline, Goffin Pierre, Guntz Julien, Deville Marine

机构信息

Department of Anesthesia and Intensive Care, MontLegia Hospital, Groupe Santé CHC, Liège, Belgium.

Laboratory of Clinical, Forensic, Industrial and Environmental Toxicology, Center for Interdisciplinary Research on Medicines, University Hospital of Liège, Liège, Belgium.

出版信息

Case Rep Crit Care. 2020 Oct 21;2020:6962591. doi: 10.1155/2020/6962591. eCollection 2020.

DOI:10.1155/2020/6962591
PMID:33145113
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7596499/
Abstract

Metformin is an oral antidiabetic largely prescribed in the treatment of type II diabetes. Overdose is associated with life-threatening lactic acidosis. We report the case of the highest metformin concentration ever described secondary to a voluntary suicidal intake. The patient developed a severe lactic acidosis and hemodynamic shock successfully treated with high-flow hemofiltration. Time to start extrarenal epuration is capital to avoid poor evolution.

摘要

二甲双胍是一种常用于治疗II型糖尿病的口服抗糖尿病药物。过量服用会导致危及生命的乳酸性酸中毒。我们报告了一例因自愿自杀性服药导致的有史以来描述的最高二甲双胍浓度的病例。该患者发生了严重的乳酸性酸中毒和血流动力学休克，通过高流量血液滤过成功治疗。开始肾外净化的时机对于避免病情恶化至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/652e/7596499/2833fb212786/CRICC2020-6962591.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/652e/7596499/2833fb212786/CRICC2020-6962591.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/652e/7596499/2833fb212786/CRICC2020-6962591.001.jpg

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本文引用的文献

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Sustained low-efficiency dialysis for metformin-associated lactic acidosis in patients with acute kidney injury.持续性低效血液透析治疗急性肾损伤合并二甲双胍相关性乳酸酸中毒
J Nephrol. 2019 Apr;32(2):297-306. doi: 10.1007/s40620-018-00562-2. Epub 2018 Dec 6.
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Review of Biguanide (Metformin) Toxicity.双胍类药物（二甲双胍）毒性综述。
J Intensive Care Med. 2019 Nov-Dec;34(11-12):863-876. doi: 10.1177/0885066618793385. Epub 2018 Aug 21.
3
Range of therapeutic metformin concentrations in clinical blood samples and comparison to a forensic case with death due to lactic acidosis.
临床血样中治疗性二甲双胍浓度范围及与一例因乳酸酸中毒死亡的法医案例的比较。
Forensic Sci Int. 2018 May;286:106-112. doi: 10.1016/j.forsciint.2018.03.003. Epub 2018 Mar 12.
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'Massive' metformin overdose.大剂量二甲双胍服用过量。
Br J Clin Pharmacol. 2018 Dec;84(12):2923-2927. doi: 10.1111/bcp.13582. Epub 2018 Apr 17.
5
Complications of regional citrate anticoagulation: accumulation or overload?局部枸橼酸抗凝的并发症：蓄积还是过载？
Crit Care. 2017 Nov 19;21(1):281. doi: 10.1186/s13054-017-1880-1.
6
Metformin intoxication: Vasopressin's key role in the management of severe lactic acidosis.二甲双胍中毒：血管加压素在严重乳酸性酸中毒治疗中的关键作用。
Am J Emerg Med. 2018 Feb;36(2):341.e5-341.e6. doi: 10.1016/j.ajem.2017.10.057. Epub 2017 Oct 28.
7
Treatment of Metformin Intoxication Complicated by Lactic Acidosis and Acute Kidney Injury: The Role of Prolonged Intermittent Hemodialysis.探讨持续性间歇性血液透析在治疗二甲双胍中毒合并乳酸性酸中毒及急性肾损伤中的作用。
Am J Kidney Dis. 2017 Aug;70(2):290-296. doi: 10.1053/j.ajkd.2016.12.010. Epub 2017 Feb 20.
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Skeletal muscle lactate overproduction during metformin intoxication: An animal study with reverse microdialysis.二甲双胍中毒期间骨骼肌乳酸过量生成：一项采用反向微透析的动物研究
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