Department of Nephrology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan.
Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan.
CEN Case Rep. 2023 Nov;12(4):408-412. doi: 10.1007/s13730-023-00783-w. Epub 2023 Mar 19.
Metformin-associated lactic acidosis is a well-known metformin treatment complication; however, the development of euglycemic diabetic ketoacidosis (euDKA) has rarely been reported. Here we report a case of lactic acidosis and euDKA after metformin overdose. A 57-year-old female patient was transferred to our hospital with severe metabolic acidosis and acute kidney injury. She had type 2 diabetes mellitus and was on oral antidiabetic therapy of vildagliptin metformin hydrochloride daily. On the admission day, she had committed suicide by overdosing 50 tablets of vildagliptin metformin hydrochloride, which was equivalent to 25,000 mg of metformin and 2500 mg of vildagliptin. She had severe lactic acidosis 5 h after overdosing. However, after 34 h of overdosing, serum lactate levels decreased while serum anion gap levels increased. She received single hemodialysis treatment. Serum total ketone bodies, β-hydroxybutyrate acetoacetic acid, and acetone were increased even after hemodialysis treatment. Her blood glucose levels have never exceeded 250 mg/dL since admission. Therefore, we considered that the cause of metabolic acidosis in this patient was not only lactic acidosis but also euDKA. The causes of euDKA in our patient might be hepatic production of ketone bodies due to metformin overdose in addition to type 2 diabetes mellitus, starvation, infection, and stressful physical conditions such as vomiting and diarrhea. We propose that not only lactic acidosis but also ketoacidosis is one of the important pathological conditions in patients with metformin overdose.
二甲双胍相关乳酸酸中毒是一种已知的二甲双胍治疗并发症；然而，血糖正常的糖尿病酮症酸中毒（euDKA）的发展很少被报道。在这里，我们报告了一例二甲双胍过量后发生的乳酸酸中毒和 euDKA。一名 57 岁女性患者因严重代谢性酸中毒和急性肾损伤转入我院。她患有 2 型糖尿病，正在接受口服降糖药维格列汀二甲双胍盐酸盐治疗，每日一次。入院当天，她因过量服用 50 片维格列汀二甲双胍盐酸盐而自杀，相当于服用 25000 毫克二甲双胍和 2500 毫克维格列汀。她在过量服用后 5 小时出现严重乳酸酸中毒。然而，在过量服用 34 小时后，血清乳酸水平下降，而血清阴离子间隙水平升高。她接受了单次血液透析治疗。即使在血液透析治疗后，血清总酮体、β-羟丁酸、乙酰乙酸和丙酮仍增加。她入院以来的血糖水平从未超过 250mg/dL。因此，我们认为该患者代谢性酸中毒的原因不仅是乳酸酸中毒，还有 euDKA。导致我们患者 euDKA 的原因可能是由于二甲双胍过量导致肝酮体生成，加上 2 型糖尿病、饥饿、感染和呕吐、腹泻等应激性身体状况。我们提出，不仅是乳酸酸中毒，还有酮症酸中毒也是二甲双胍过量患者的重要病理状态之一。
