Metformin-Associated Lactic Acidosis in Type 2 Diabetic Patients with Acute Kidney Injury

發生急性腎損傷的第二型糖尿病患併發Metformin相關的乳酸中毒

簡誌銘(Chih-Ming Chien) ； 林正浩(Jeng-Haw Lin) ； 戴研光(Yen-Kuang Tai)

《南臺灣醫學雜誌》 8卷2期 (2012/12) Pp. 61-68

https://doi.org/10.6726/MJST.201212_8(2).0002

摘要

目的：乳酸中毒一直是臨床醫師在使用metformin治療時所擔憂的罕見卻嚴重的併發症，本研究旨在描述metformin相關的乳酸中毒的臨床表現及急性腎損傷對此疾病之影響。方法：收集五年內某區域醫院診斷為metformin相關的乳酸中毒個案，經排除其他原因所導致的高乳酸血症之後，進行回溯性分析發病前病況、臨床表徵、生化數據、治療策略及預後。結果：共計有10位個案符合metformin相關的乳酸中毒診斷，全部是老年糖尿病患且合併急性腎損傷，每位病患都有至少一個血管性的合併症。多數病患於發病前都有發生或使用可能惡化腎功能的急症或藥物。腸胃不適、低血糖、低體溫及低血壓是主要的臨床表徵。其中兩位接受呼吸器治療，四位需要升壓劑維持血壓，七位接受緊急洗腎以清除酸中毒及治療腎衰竭。合併顯影劑及metformin的使用，導致本研究唯一的死亡案例。存活者的腎功能通常都可恢復。結論：metformin相關的乳酸中毒常見於發生急性腎損傷的病患，此症雖然嚴重，單純因metformin引起的乳酸中毒症在心血管、呼吸及腎臟系統施予積極的支持治療之下，預後似乎不差。

關鍵字

metformin ； 乳酸中毒 ； 急性腎損傷 ； 糖尿病

並列摘要

Objective: Lactic acidosis, a rare but serious complication of metformin treatment, is always a major concern of clinicians. This study aimed to describe the clinical profile of metformin-associated lactic acidosis (MALA) and the impact of acute kidney injury.Methods: We conducted a retrospective study, excluding other causes of hyperlactatemia, to identify patients with MALA in a regional hospital during a 5-year period. The pre-morbid conditions, clinical presentation, biochemical data, therapeutic strategies and outcomes were recorded for analysis.Results: A total of 10 cases were diagnosed as MALA. All were elderly type 2 diabetic patients accompanied with acute kidney injury at presentation. All patients had more than one vascular comorbidity. Most patients had acute intercurrent illness or took medications that might compromise renal function. Gastrointestinal symptoms, hypoglycemia, hypothermia and hypotension were predominant clinical features. Among them, two patients were ventilated, four patients required vasoactive support and seven patients received urgent hemodialysis to clear the acidosis and treat the renal failure. All but one of these patients survived. A combination of contrast medium and metformin led to the only mortality case. Recovery of renal function was the general rule in survivors.Conclusions: MALA is usually associated with acute kidney injury. Despite the severity of this illness, lactic acidosis solely related to metformin use seems to have a favorable outcome with intensive support of cardiovascular, respiratory and renal system.

並列關鍵字

metformin ； lactic acidosis ； acute kidney injury ； diabetes mellitus