Rasuli P, Hammond D I
Department of Radiology, University of Ottawa, Ont.
Can Assoc Radiol J. 1998 Jun;49(3):161-6.
Intravascular administration of iodinated contrast media to patients who are receiving metformin, an oral antidiabetic agent, can result in lactic acidosis. However, this rare complication occurs only if the contrast medium causes renal failure, and the patient continues to take metformin in the presence of renal failure. Because metformin is excreted primarily by the kidneys, continued intake of metformin after the onset of renal failure results in a toxic accumulation of this drug and subsequent lactic acidosis. To avoid this complication, metformin must be withheld after the administration of the contrast agent for 48 hours, during which the contrast-induced renal failure becomes clinically apparent. If renal function is normal at 48 hours, the metformin can be restarted. There is no scientific justification for withholding metformin for 48 hours before administration of the contrast medium, as currently recommended in the package insert. The authors review the pharmacology of metformin and present a departmental policy for managing patients with diabetes who receive metformin and who require intravascular administration of iodinated contrast media.
对于正在接受口服抗糖尿病药物二甲双胍治疗的患者，血管内注射碘化造影剂可能会导致乳酸性酸中毒。然而，这种罕见的并发症仅在造影剂导致肾衰竭且患者在肾衰竭情况下继续服用二甲双胍时才会发生。由于二甲双胍主要通过肾脏排泄，肾衰竭发作后继续摄入二甲双胍会导致该药物的毒性蓄积并随后引发乳酸性酸中毒。为避免这种并发症，在注射造影剂后必须停用二甲双胍48小时，在此期间造影剂诱发的肾衰竭会在临床上显现出来。如果48小时时肾功能正常，可重新开始服用二甲双胍。如药品说明书目前所推荐的那样，在注射造影剂前停用二甲双胍48小时并无科学依据。作者回顾了二甲双胍的药理学，并提出了一项针对接受二甲双胍治疗且需要血管内注射碘化造影剂的糖尿病患者的科室管理策略。
