Misbin R I
Ann Intern Med. 1977 Nov;87(5):591-5. doi: 10.7326/0003-4819-87-5-591.
Since phenformin's introduction into clinical medicine, a total of 552 cases of lactic acidosis have been reported in patients taking this hypoglycemic agent. In 306 cases, sufficient documentation was available to establish the diagnosis with reasonable certainty (blood lactate, 6 meq/litre or greater, and blood pH, 7.33 or less). The mortality rate among insulin-treated patients (15%) was considerably less than the mortality rate in the group as a whole (42%). Taken together with results from animal studies, these data suggest that insulin is the treatment of choice for phenformin-associated lactic acidosis. Sodium bicarbonate should be administered to patients with severe acidosis, but should be withheld from patients with mild acidosis. Overly aggressive administration of sodium bicarbonate can be deleterious and should be avoided. Although dialysis has been suggested by some authors for the treatment of phenformin-associated lactic acidosis, the mortality rate among dialyzed patients (48%) was roughly the same as for the group as a whole (42%).
自从苯乙双胍被引入临床医学以来，服用这种降糖药的患者共报告了552例乳酸酸中毒病例。在306例病例中，有足够的资料能够合理确定地做出诊断（血乳酸≥6毫当量/升，血pH≤7.33）。胰岛素治疗患者的死亡率（15%）明显低于整个组的死亡率（42%）。结合动物研究结果，这些数据表明胰岛素是苯乙双胍相关乳酸酸中毒的首选治疗方法。严重酸中毒患者应给予碳酸氢钠，但轻度酸中毒患者不应给予。过度积极地给予碳酸氢钠可能有害，应避免。尽管一些作者建议采用透析治疗苯乙双胍相关乳酸酸中毒，但接受透析患者的死亡率（48%）与整个组的死亡率（42%）大致相同。
