乳酸血症是metformin治療第二型糖尿病或服藥過量意圖自殺時少見但嚴重的併發症。我們報告一位第二型糖尿病合併慢性腎衰竭的病患，服用metformin自殺後發生低血糖、低體溫、心搏過速與持續惡化之乳酸血症。此病患僅單純服用metformin卻發生低血糖，利用連續性靜脈對靜脈血液過濾治療時，初期仍然持續有乳酸升高情形。當預存有慢性疾病的病患意圖自殺、服藥過量而出現高陰離子間隙代謝性酸中毒時，應考慮是metformin過量。早期診斷，儘早使用血液透析或血液過濾，同時穩定血壓、給予矯正低血糖與低體溫等支持治療，可以改善預後。
Metformin-associated lactic acidosis is a very rare but critical condition. It is seen in patients with type 2 diabetes mellitus who take metformin and attempt suicide with a metformin overdose. Here, we report a 43-year-old woman with type 2 diabetes mellitus and chronic renal insufficiency who developed hypoglycemia, hypothermia, tachycardia and lactic acidosis after a suicide attempt with a metformin overdose. She was successfully treated by continuous venovenous hemofiltration, and adequate hemodynamic and ventilatory support. Although metformin does not usually cause hypoglycemia when administered as monotherapy, hypoglycemia can occur in a condition coexistent with lactic acidosis secondary to metformin overdose. Metformin intoxication should be suspected when patients present with high anion gap metabolic acidosis after attempting suicide by ingesting drugs, particularly when comorbidities such as renal failure are present. Early diagnosis and rapid correction of the metabolic acidosis using hemodialysis or hemofiltration, together with concomitant cardiovascular support, and maintenance of blood glucose and core body temperature, provide the possibility of a positive outcome.
關聯:
The Kaohsiung Journal of Medical Sciences v.25 n.2 P.93-97
