BACKGROUND Metformin has been widely used as a first-line agent to treat type 2 diabetes mellitus. Lactic acidosis is a rare but serious adverse effect in patients treated with metformin. Recent studies noted a correlation between metformin accumulation and lactic acidosis. Continuous renal replacement therapy for the treatment of metformin-associated lactic acidosis has been documented in some case reports; however, there is currently no specific treatment for metformin-associated lactic acidosis. CASE PRESENTATION A 70-year-old Japanese woman with type 2 diabetes mellitus presented to an emergency room with metformin-associated lactic acidosis. She was found to be hypotensive and laboratory examinations revealed severe lactic acidosis: pH 6.618, partial pressure of carbon dioxide in arterial blood 17.3 mmHg, bicarbonate 1.7 mmol/L, and lactate 18 mmol/L. Severe acidemia persisted despite supportive care including intravenously administered fluids, sodium bicarbonate, antibiotics, and vasopressors. Continuous renal replacement therapy was initiated in our intensive care unit. After dialysis for 3 days, her lactate level and pH value completely normalized. The concentration of metformin detected was 77.5 mg/L, which is one of the highest in metformin-associated lactic acidosis successfully treated without overdose. CONCLUSIONS The present case had one of the highest metformin concentrations in metformin-associated lactic acidosis successfully treated with continuous renal replacement therapy, and serum metformin concentrations may be useful for the diagnosis of metformin-associated lactic acidosis. Metformin-associated lactic acidosis is a rare but important etiology of lactic acidosis. Continuous renal replacement therapy is advantageous for the treatment of hemodynamically unstable patients with metformin-associated lactic acidosis.

中文翻译：

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一名二甲双胍相关乳酸性酸中毒患者通过连续肾脏替代疗法成功治疗：病例报告。


背景技术二甲双胍已被广泛用作治疗2型糖尿病的一线药物。乳酸酸中毒是二甲双胍治疗患者罕见但严重的不良反应。最近的研究指出二甲双胍蓄积与乳酸性酸中毒之间存在相关性。一些病例报告记录了连续肾脏替代疗法治疗二甲双胍相关的乳酸性酸中毒；然而，目前尚无针对二甲双胍相关乳酸性酸中毒的具体治疗方法。病例介绍 一名 70 岁的日本女性患有 2 型糖尿病，因二甲双胍相关的乳酸性酸中毒被送往急诊室。发现她血压低，实验室检查显示严重乳酸性酸中毒：pH 6.618，动脉血二氧化碳分压17.3 mmHg，碳酸氢盐1.7 mmol/L，乳酸18 mmol/L。尽管采取了支持治疗，包括静脉注射液体、碳酸氢钠、抗生素和血管加压药，但严重酸血症仍然存在。我们的重症监护病房开始了连续的肾脏替代治疗。透析3天后，她的乳酸水平和pH值完全正常化。检测到的二甲双胍浓度为 77.5 mg/L，这是在未服用过量的情况下成功治疗二甲双胍相关乳酸性酸中毒的最高浓度之一。结论 本病例是连续肾脏替代治疗成功治疗的二甲双胍相关乳酸性酸中毒中二甲双胍浓度最高的病例之一，血清二甲双胍浓度可能有助于诊断二甲双胍相关性乳酸性酸中毒。二甲双胍相关的乳酸性酸中毒是一种罕见但重要的乳酸性酸中毒病因。 连续肾脏替代治疗有利于治疗血流动力学不稳定的二甲双胍相关乳酸性酸中毒患者。