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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). Methods: One case of severe MALA was collected and reviewed. Results: Long-term use of metformin in patients with early symptoms of abdominal pain, diarrhea associated with vomiting, rapid progress, sudden unconsciousness, sudden cardiac arrest in the emergency, spontaneous circulation after recovery of hemodynamic instability, secondary to myocardial, Pancreatic damage, blood pH 6.895, lactate 28mmol / L, anion gap (AG) 44.5mmol / L, given liquid resuscitation, a large number of added sodium bicarbonate, cardiac pressure boost, respiratory support and other rescue measures, acidosis is difficult to correct, Continuous blood purification, the final success. Conclusions: MALA is a rare and serious complication with high mortality. Significant hyperlactic acidosis and high-AG metabolic acidosis are the main points of diagnosis. Clinical manifestations are more nonspecific, not timely diagnosis and treatment, complicated by multiple organs Functional impairment, the treatment taken to correct acidosis-based comprehensive measures, critically ill patients need continuous line of blood purification.