Kwong S C, Brubacher J
Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, New York, New York, USA.
J Emerg Med. 1998 Nov-Dec;16(6):881-6. doi: 10.1016/s0736-4679(98)00103-6.
Phenformin was removed from the U.S. market 20 years ago because of a high incidence of lactic acidosis. Unfortunately, this medication is still available from foreign sources. Another biguanide, metformin, was reintroduced to the United States market for the treatment of diabetes. Biguanide-induced lactic acidosis should be included in the differential diagnosis of elevated anion gap metabolic acidosis. We present a case of phenformin-induced lactic acidosis in which we were consulted at the local poison control center. We also review its pathophysiology, presentation, and treatment. A review of the actions of phenformin illustrates the mechanism of pathology that may also occur with metformin. Risk factors for the development of lactic acidosis include renal deficiency, hepatic disease, cardiac disease, and drug interaction such as cimetidine.
由于乳酸酸中毒发生率高，苯乙双胍于20年前从美国市场撤市。不幸的是，这种药物仍可从国外获得。另一种双胍类药物二甲双胍被重新引入美国市场用于治疗糖尿病。双胍类药物引起的乳酸酸中毒应纳入阴离子间隙升高的代谢性酸中毒的鉴别诊断中。我们报告一例苯乙双胍引起的乳酸酸中毒病例，当地毒物控制中心向我们咨询了该病例。我们还回顾了其病理生理学、临床表现及治疗方法。对苯乙双胍作用的综述阐明了二甲双胍也可能出现的病理机制。乳酸酸中毒发生的危险因素包括肾功能不全、肝脏疾病、心脏疾病以及与西咪替丁等药物的相互作用。
