Department of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
CEN Case Rep. 2022 May;11(2):278-282. doi: 10.1007/s13730-021-00665-z. Epub 2021 Nov 27.
We report the case of metformin-associated lactic acidosis (MALA) exacerbated by acute kidney injury (AKI) in a 65-year-old Asian American woman who was an overseas traveler. She had vomiting and diarrhea before arriving in Osaka, Japan, from the Philippines. She suffered from worsening respiratory distress, consciousness loss and anuria the day after coming to Japan. When she arrived at our emergency room via ambulance, she appeared to be in a state shock. Arterial blood gas analysis revealed severe lactic acidosis (pH 6.681, PO 302 Torr under O supplementation, PCO 15 Torr, HCO1.7 mmol/L, and lactate 17.00 mmol/L). She also had renal failure (BUN 108 mg/dL and serum creatinine 8.68 mg/dL) with hyperkalemia (6.1 mEq/L). We collected medical information from family members, and found her prescription medicines including metformin, diuretics and angiotensin-converting enzyme inhibitor (ACEI). We diagnosed her with MALA due to an unintended overdose of metformin resulting from acute kidney injury that can be induced by ACEI and diuretics in the volume-depleted condition. We immediately started hemodialysis therapy. Although she had a temporary cardiopulmonary arrest at the beginning of the treatment, her physical status was gradually improved and the severe acidemia resolved. On hospital day 4, she had urine and no longer needed hemodialysis therapy. On day 14, she was discharged and returned to the United States without noticeable sequelae. This is a case report of an overseas traveler who was successfully rescued through the collection of accurate medical information and understanding of the pathological condition.
我们报告了一例由出国旅行者（一位 65 岁的亚裔美国女性）并发急性肾损伤（AKI）而加重的二甲双胍相关乳酸性酸中毒（MALA）病例。她在从菲律宾前往日本大阪之前出现了呕吐和腹泻。抵达日本的第二天，她的呼吸窘迫恶化，失去意识并出现无尿。当她通过救护车到达我们的急诊室时，她似乎处于休克状态。动脉血气分析显示严重的乳酸性酸中毒（pH 值 6.681，在补充氧气的情况下 PO 302 托，PCO 15 托，HCO1.7 mmol/L，和乳酸 17.00 mmol/L）。她还患有肾衰竭（BUN 108 mg/dL 和血清肌酐 8.68 mg/dL）和高钾血症（6.1 mEq/L）。我们从家属那里收集了医疗信息，并发现她正在服用包括二甲双胍、利尿剂和血管紧张素转换酶抑制剂（ACEI）在内的处方药物。我们诊断她患有 MALA，这是由于 ACEI 和利尿剂在容量不足的情况下引起的急性肾损伤导致的二甲双胍意外过量。我们立即开始进行血液透析治疗。尽管在治疗开始时她曾出现短暂的心搏骤停，但她的身体状况逐渐改善，严重酸中毒得到缓解。在住院第 4 天，她开始排尿，不再需要血液透析治疗。在第 14 天，她出院并返回美国，没有明显的后遗症。这是一例出国旅行者的病例报告，通过准确收集医疗信息和了解病理状况，成功地对她进行了救治。
