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題名 | Metformin-Associated Lactic Acidosis Due to Acute Renal Failure after Contrast Medium Injection: Two Case Reports and Review of the Literature=因注射顯影劑造成急性腎衰竭後合併使用Metformin併發乳酸中毒:兩病例報告及文獻回顧 |
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作者 | 謝昌勳; 鄭啟源; 洪乙仁; 郭熙文; 裴馰; Hsieh, Chang-hsun; Jeng, Chii-yuan; Hung, Yi-jen; Wen, Guo-hsi; Pai, Dee; |
期刊 | 醫學研究 |
出版日期 | 20010200 |
卷期 | 21:1 2001.02[民90.02] |
頁次 | 頁58-64 |
分類號 | 418.271 |
語文 | eng |
關鍵詞 | 乳酸中毒; 急性腎衰竭; Lactic acidosis; Metformin; Acute renal failure; |
中文摘要 | Metformin是口服降血糖藥物之一種,常用於治療糖尿病。Metformin目前在世界各國被廣泛使用。這裡我們報導兩位糖尿病病患在注射顯影劑之後造成急性腎衰竭,且因同時合併使用Metformin造成乳酸中毒。經過積極之治療,包括水分之補充、重碳酸鹽補充、血液透析治療和呼吸機治療。一位病人完全康復且無任何後遺症。但另一病患於腎功能恢復正常後呈現植物人狀態。美國糖尿病學會於1995年報導,因使用Metmormin所造成之乳酸中毒其死亡率高達百分之五十。所以在某些情況之下小心使用Metformin,及早認知及治療乳酸中毒將可改善病人之預後。 |
英文摘要 | Metformin is one of a class of oral hypoglycemic agents (OHA) commonly used in the treatment of diabetes mellitus. Metformin is in common use in many countries all over the world at present. Here we report two cases of diabetic patients, one is 64-year-old woman and the other 72-year-old male. They received iodinated contrast media examination without discontinuance of metformin. Both of them developed symptoms of nausea and vomiting initially, followed by shortness of breath and loss of consciousness. Metformin associated lactic acidosis (MALA) after an episode of acute renal failure caused by iodinated contrast media injection was the final diagnosis via marked highly level of plasma lactic acid. Aggressive therapy, including adequate hydration with 0.9% normal saline fluid, bicarbonate administration, bicarbonate-based buffering hemodialysis, and mechanical ventilator support were done. One patient's condition and renal function were fully recovered later without any sequela. But the latter one developed vegetable status after recovering his vital signs and renal function. The reported mortality rate of MALA is about 50% via data of America Diabetes Association (ADA) after 1995. It will improve the prognosis and outcome if used cautiously in certain conditions, early recognizing and aggressive therapy. |
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