测量阴离子间隙在诊断二甲双胍相关性乳酸酸中毒中的作用：病例系列。
The usefulness of measuring the anion gap in diagnosing metformin-associated lactic acidosis: a case series.
机构信息
Pharmacy Department, Hospital Santa Creu i Sant Pau, C/San Quintín 89, 08041, Barcelona, Spain.
Emergency Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
出版信息
J Med Case Rep. 2021 Jan 21;15(1):17. doi: 10.1186/s13256-020-02655-8.
BACKGROUND
Metformin-associated lactic acidosis (MALA) is a widely documented adverse event of metformin. Despite being considered one of the main causes of metabolic acidosis, the association between an anion gap and MALA diagnosis is still uncertain.
CASE PRESENTATION
Cases involving six Caucasian patients with suspected MALA who were admitted to the emergency department were analysed. All these patients presented with pH values < 7.35, lactate levels > 2 mmol/L, and estimated glomerular filtration < 30 mL/min. Metformin plasma concentrations were > 2.5 mg/L in all the patients. The highest metformin concentrations were not found in the patients with the highest lactate levels. The anion gap values ranged from 12.3 to 39.3, with only two patients exhibiting values > 14.
CONCLUSIONS
In patients with MALA, there is a significant variability in the anion gap values, which is not related to the level of metformin accumulation, and therefore, it is doubtful whether measuring anion gaps is useful as an approach for MALA diagnosis.
背景
二甲双胍相关性乳酸酸中毒（MALA）是二甲双胍广泛报道的不良事件。尽管阴离子间隙（anion gap）被认为是代谢性酸中毒的主要原因之一，但阴离子间隙与 MALA 诊断之间的关联仍不确定。
病例介绍
分析了 6 例疑似 MALA 的白人患者，这些患者均因酸中毒而收入急诊病房。所有患者的 pH 值均<7.35，乳酸水平>2mmol/L，肾小球滤过率估计值<30mL/min。所有患者的二甲双胍血浆浓度均>2.5mg/L。在乳酸水平最高的患者中并未发现最高的二甲双胍浓度。阴离子间隙值范围为 12.3 至 39.3，只有两名患者的数值>14。
结论
在 MALA 患者中，阴离子间隙值存在显著差异，且与二甲双胍蓄积水平无关，因此，阴离子间隙测量对 MALA 诊断是否有用值得怀疑。
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