Metformin-associated lactic acidosis treated with continuous renal replacement therapy.
Metformin-associated lactic acidosis treated with continuous renal replacement therapy.
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DOI：
10.1136/bcr-2016-218318
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发表时间：
2017-02-10
期刊：
影响因子：
0.9
通讯作者：
Katayama, Naoyuki
中科院分区：
文献类型：
--
作者：
Nakamura, Akihide;Suzuki, Kei;Katayama, Naoyuki
二甲双胍相关性乳酸酸中毒（MALA）是一种罕见但危及生命的并发症。我们报告一例MALA患者，男，71岁，接受连续性肾脏替代治疗（CRRT）。患者因胃肠道症状延长和逐渐恶化而被送往医院。虽然他接受了静脉治疗，但他发生了儿茶酚胺抵抗性休克，血气分析显示乳酸酸中毒。针对可能的脓毒症，开始使用Bicycline和抗生素，但无明显获益。由于血液动力学不稳定伴代谢性酸中毒，给予紧急CRRT：立即有效降低乳酸水平; pH值在18小时内完全恢复正常，患者病情稳定。 MALA有时会出现非特异性症状，在治疗无法解释的代谢性酸中毒时需要考虑。在严重病例中，CRRT具有潜在优点，尤其是在血流动力学不稳定的患者中。重要的是要熟悉MALA作为一种医疗紧急情况，即使是急诊医生。
Metformin-associated lactic acidosis (MALA) is a rare but life-threatening complication. We report a case of MALA in a man aged 71 years who was treated with continuous renal replacement therapy (CRRT). The patient was brought to the hospital for prolonged and gradual worsening gastrointestinal symptoms. Although he received intravenous treatment, he developed catecholamine-resistant shock, and blood gas analysis revealed lactic acidosis. Bicarbonate and antibiotics for possible sepsis were initiated, but with no clear benefit. Owing to haemodynamic instability with metabolic acidosis, urgent CRRT was given: it was immediately effective in reducing lactate levels; pH values completely normalised within 18 hours, and he was stabilised. MALA sometimes presents with non-specific symptoms, and is important to consider when treating unexplainable metabolic acidosis. In severe cases, CRRT has potential merit, particularly in haemodynamically unstable patients. It is important to be familiar with MALA as a medical emergency, even for emergency physicians.