摘要
目的:探讨二甲双胍相关性糖尿病乳酸性酸中毒(MALA)的临床特点及治疗。方法:收集1例重症MALA的临床资料,并进行相关文献复习。结果:患者长期服用二甲双胍,病初表现为腹痛、腹泻伴呕吐,进展迅速,突发意识不清,在急诊时心跳骤停,自主循环恢复后血流动力学不平稳,继发心肌、肾脏、胰腺损害,血pH 6.895,乳酸28mmol/L,阴离子间隙(AG)44.5mmol/L,给予液体复苏、大量补充碳酸氢钠、强心升压、呼吸支持等抢救措施,酸中毒难以纠正,及时采用连续性血液净化,最后获得成功。结论:MALA是一种罕见的严重并发症,死亡率高,显著的高乳酸血症和高AG型代谢性酸中毒是其诊断要点,临床表现多无特异性,不及时诊治,易并发多器官功能损害,治疗上采取纠正酸中毒为主的综合措施,重症患者需尽早行连续性血液净化。
Objective：To investigate the clinical features and treatment of metformin-associated lactic acidosis （MALA）. Method：The clinical data of one patient with severe MALA was collected and related literatures were reviewed. Result A 67-yeaold man patient with Type 2 diabetes mellitus took long term use of metformin. At the beginning, the symptoms were abdominal pain, diarrhea and vomiting, then condition progressed very fast. The patient suddenly became unconscious and soon suffered cardiac arrest in the emergency room. After restoration of spontaneous circulation,his hemodynamics was unstable and the secondary damage to heart,kidneys, and pancreas occurred. Laboratory evaluation found a serum pH nadir of 6. 895 ,a serum lactate level of 28 mmol/L and an anion gap（AG） of 44.5 retool/Despite initial applications including fluid resuscitation,intravenous infusion of large a mounts of bicarbonate, cardiovascular and respiratory support, metabolic acidosis was very difficult to reverse. Fi- nally he got better because of treating with continuous blood purification（CBP） urgently. Conclusion MALA is a severe and rare complication with high mortality and has an atypical clinical manifestations. Lactic acidosis signifi cantly and high-AG metabolic acidosis is the main points of diagnosis. It is easy to be complicated with multi-organ damage without timely diagnosis and treatment. Comprehensive measures mainly including the correction of acidosis should be adopted. The early implementation of CBP are needed in severe cases.
出处
《临床急诊杂志》
CAS
2014年第10期618-622,共5页
Journal of Clinical Emergency
