University Medical Center Phoenix, University of Arizona College of Medicine Toxicology Fellowship, 1111 E McDowell Rd, Building A, Fl 2, Phoenix, AZ 85006-2749, USA.
Banner - University Medical Center Phoenix, Department of Toxicology, 1111 E McDowell Rd, Building A, Fl 2, Phoenix, AZ 85006-2749, USA.
Am J Emerg Med. 2023 Jun;68:216.e1-216.e3. doi: 10.1016/j.ajem.2023.02.038. Epub 2023 Mar 2.
A 53-year-old man died following a reported ingestion of 80 g of his metformin tablets resulting in severe, refractory shock and metformin-associated lactic acidosis. His peak serum metformin concentration was 53 μg/mL (therapeutic range 1-2 μg/mL), peak lactic acid concentration was 49.7 mmol/L, and arterial pH nadir was 7.06. He died despite vasopressors and renal replacement therapy [RRT; both intermittent hemodialysis (IHD) and continuous venovenous hemodiafiltration (CVVHDF)]. Serial metformin concentrations during CVVHDF suggested a half-life of 33-h. Similar to previous reports of RRT for metformin toxicity, CVVHDF appears to provide first-order elimination of metformin.
一名 53 岁男性因摄入 80 克二甲双胍片后出现严重、难治性休克和二甲双胍相关性乳酸性酸中毒而死亡。他的血清二甲双胍峰浓度为 53μg/mL（治疗范围 1-2μg/mL），乳酸峰浓度为 49.7mmol/L，动脉 pH 最低值为 7.06。尽管使用了升压药和肾脏替代治疗[RRT；间歇性血液透析（IHD）和连续静脉-静脉血液透析滤过（CVVHDF）]，他还是死亡了。CVVHDF 期间的连续二甲双胍浓度提示半衰期为 33 小时。与 RRT 治疗二甲双胍毒性的先前报告类似，CVVHDF 似乎提供了二甲双胍的一级消除。
