Metformin-associated lactic acidosis: A prognostic and therapeutic study
Metformin-associated lactic acidosis: A prognostic and therapeutic study
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DOI：
10.1097/ccm.0b013e3181a02490
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发表时间：
2009-07-01
影响因子：
8.8
通讯作者：
Fourrier, Francois
中科院分区：
文献类型：
--
作者：
Seidowsky, Alexandre;Nseir, Saad;Fourrier, Francois
目标.二甲双胍相关性乳酸酸中毒是双胍类药物治疗的一种罕见而严重的并发症。它通常发生在突发性疾病引起急性肾衰竭和偶然过量时。自愿中毒是罕见的。推荐使用双氢叶酸血液透析（HD）来降低二甲双胍水平和纠正酸中毒，但其最佳持续时间尚未确定。本研究的目的是记录故意和偶然二甲双胍过量的特点和预后因素，并确定最佳的持续时间HD.Design：10年回顾性分析重症监护病房二甲双胍相关的乳酸酸中毒的患者。设置：两个重症监护病房（50张病床）在一所大学hospital.Measurements和主要结果。记录HD期间的临床和生物学特征、器官衰竭和连续二甲双胍水平。纳入42例患者（13例自愿中毒和29例偶然过量）; 74%的患者患有急性肾衰竭，需要HD。故意用药过量患者中未观察到死亡，而偶然用药过量患者的死亡率为48.3%。与死亡率显著相关的因素是logistic器官功能障碍系统评分、pH、血浆乳酸和凝血酶原活动度。通过多变量分析，
Objectives. Metformin-associated lactic acidosis is a rare and serious complication of biguanide treatment. It usually occurs when a precipitating disease induces an acute renal failure and an incidental overdose. Voluntary intoxication is rare. Bicarbonate hemodialysis (HD) is recommended to decrease metformin levels and correct acidosis but its optimal duration has not been determined. This study was designed to document the characteristics and prognostic factors of intentional and incidental metformin overdose and to determine the optimal duration of HD.Design: Ten years retrospective analysis of patients admitted in intensive care unit for metformin-associated lactic acidosis.Setting: Two intensive care units (50 beds) in a university hospital.Measurements and Main Results. Clinical and biological characteristics, organ failures, and sequential metformin levels during HD were recorded. Forty-two patients were included (13 voluntary intoxications and 29 incidental overdoses); 74% of patients were in acute renal failure and needed HD. No death was observed in intentional overdose patients compared with 48.3% mortality in incidental overdose patients. The factors significantly associated with mortality were logistic organ dysfunction system score, pH, plasma lactate, and prothrombin activity. By multivariate analysis, a prothrombin activity