Metformin-associated lactic acidosis in an intensive care unit
Metformin-associated lactic acidosis in an intensive care unit
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DOI：
10.1186/cc7137
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发表时间：
2008-01-01
期刊：
影响因子：
15.1
通讯作者：
Gibot, Sebastien
中科院分区：
文献类型：
--
作者：
Peters, Nicolas;Jay, Nicolas;Gibot, Sebastien
前言二甲双胍相关性乳酸酸中毒(Mala)是二甲双胍的典型副作用，是一种严重的疾病，病死率高。透析治疗Mala是有争议的，也是文献中许多病例报告的主题。我们的目的是评估16张病床的大学附属重症监护病房(ICU)中Mala的患病率，以及透析对患者预后的影响。方法在五年的时间里，我们回顾了所有住进ICU的患者，这些患者要么以二甲双胍作为常规药物，要么因服用二甲双胍而自杀未遂。在这一人群中，我们选择了表现为乳酸中毒的患者，从而定义了MLA，并描述了他们的临床和生物学特征。结果MLA占研究期间所有住院患者的0.84%(5年内收治30例MLA)，与30%的死亡率相关。与死亡结局相关的唯一因素是住进ICU的原因和最初的凝血酶原时间。尽管血液透析患者的病情严重程度评分高于未透析患者，但两组患者的死亡率相似(31.3%对28.6%)。结论每年在ICU可发生数次Mala，但仍是一种危及生命的情况。治疗主要限于支持性措施，尽管血液透析可能具有保护作用。
Introduction Metformin-associated lactic acidosis (MALA) is a classic side effect of metformin and is known to be a severe disease with a high mortality rate. The treatment of MALA with dialysis is controversial and is the subject of many case reports in the literature. We aimed to assess the prevalence of MALA in a 16-bed, university-affiliated, intensive care unit (ICU), and the effect of dialysis on patient outcome.Methods Over a five-year period, we retrospectively identified all patients who were either admitted to the ICU with metformin as a usual medication, or who attempted suicide by metformin ingestion. Within this population, we selected patients presenting with lactic acidosis, thus defining MALA, and described their clinical and biological features.Results MALA accounted for 0.84% of all admissions during the study period (30 MALA admissions over five years) and was associated with a 30% mortality rate. The only factors associated with a fatal outcome were the reason for admission in the ICU and the initial prothrombin time. Although patients who went on to haemodialysis had higher illness severity scores, as compared with those who were not dialysed, the mortality rates were similar between the two groups (31.3% versus 28.6%).Conclusions MALA can be encountered in the ICU several times a year and still remains a life-threatening condition. Treatment is restricted mostly to supportive measures, although haemodialysis may possess a protective effect.