Anaesthesia and Intensive Care, Aalborg Universitetshospital, Aalborg, Denmark.
Cardiology, Aalborg Universitetshospital, Aalborg, Denmark.
BMJ Case Rep. 2023 Aug 16;16(8):e254649. doi: 10.1136/bcr-2023-254649.
Metformin-associated lactic acidosis (MALA) is a serious condition with high mortality. This case describes a man in the mid-60s with diabetes mellitus type 2 treated with metformin developing MALA 4 days after coronary stenting for non-ST-elevation myocardial infarction. He presented acutely with severe abdominal pain, a lactate of 19 mmol/L and pH 6.74. Despite treatment for MALA, he went into refractory cardiac arrest and was connected to venoarterial extracorporeal membrane oxygenation (VA-ECMO). He suffered a massive haemothorax due to perforation of the right atrial appendage. It was repaired through a sternotomy while being given massive blood transfusions. The following days, he was on VA-ECMO and double continuous venovenous haemodialysis (CVVHD). He survived with only mild paresis of the left hand. VA-ECMO should be considered a rescue therapy alongside treatment with CVVHD in case of cardiac arrest due to severe MALA.
二甲双胍相关乳酸酸中毒（MALA）是一种死亡率很高的严重疾病。本例描述了一名 60 多岁的男性，患有 2 型糖尿病，正在接受二甲双胍治疗，在非 ST 段抬高型心肌梗死行冠状动脉支架置入术后 4 天发生 MALA。他突然出现严重腹痛、乳酸 19mmol/L 和 pH 值 6.74。尽管对 MALA 进行了治疗，但他还是出现难治性心搏骤停，并连接了静脉-动脉体外膜肺氧合（VA-ECMO）。他因右心耳穿孔而发生大量血胸。在进行大量输血的同时，通过胸骨切开术进行了修复。接下来的几天，他一直在接受 VA-ECMO 和双连续静脉-静脉血液透析（CVVHD）治疗。他幸存下来，只有左手轻度瘫痪。如果由于严重的 MALA 导致心搏骤停，VA-ECMO 应与 CVVHD 治疗一起考虑作为抢救治疗。
