- 期刊
Metformin Associated High Anion Gap Metabolic Acidosis: A Case Report
Metformin引起之高陰離子間隙代謝性酸中毒
摘要
Metformin是一種口服的降血糖藥，目前已被廣泛使用在治療第二型糖尿病病患。雖然少見，該藥卻潛藏著致命的併發症：乳酸性酸中毒。可能致病的危險因子包括：高齡、腎功能不全、以及任何可能導致組織缺氧之因素，如敗血症、心肌梗塞等。在此我們報告一位72歲男性因為服用Metformin造成嚴重的代謝性酸中毒。病患因意識不清入院，臨床表現有低血糖、低血壓、低體溫、心博過緩、急性腎衰竭及呼吸衰竭。檢驗數值呈現高陰離子間隙之代謝性酸中毒(46.5 mEq/L)，無法以高劑量重碳酸鹽矯正。回顧用藥史發現，病人腎功能不佳卻仍使用大劑量Metformin治療糖尿病。經安排緊急洗腎後病人的症狀迅速緩解。臨床醫師應對Metformin引起代謝性酸中毒之臨床症狀有所警覺。死亡原因包括急性腎衰竭、電解值不平衡、心律不整及心血管功能衰竭。重碳酸鹽無法改善其代謝性酸中毒，治療的選擇為安排血液透析。若能儘早治療，病患的預後通常很好。
並列摘要
Metformin, a hypoglycemic agent, has been widely used to treat patients with type 2 diabetes mellitus; however, it might be related to a fatal complication: lactic acidosis. Risk factors include old age, renal function impairment, and any condition associated with tissue hypoxia, such as sepsis and myocardial infarction. Here we present a case with severe metabolic acidosis due to metformin intoxication. The 72-year-old male patient felt drowsy at home. Clinical presentations included hypoglycemia, hypotension, hypothermia, bradycardia, acute renal deterioration, and respiratory failure. Laboratory data revealed high anion gap metabolic acidosis (46.5 mEq/L) which was intractable with high doses of sodium bicarbonate. After reviewing the patient's history, we found large doses of metformin were prescribed for diabetes mellitus. Emergent hemodialysis was arranged after other possibilities were excluded and the symptoms recovered rapidly. Physicians should be familiar with clinical symptoms of metformin intoxication. Morbidity and death due to metformin intoxication include acute renal failure, electrolyte disturbance, arrhythmia and cardiovascular suppression. The role of sodium bicarbonate in the treatment is limited. Hemodialysis is the treatment of choice and should be urgently initiated.