苯乙双胍过量致乳酸酸中毒

Lactic acidosis resulting from phenformin overdose

1例24岁女性患者一次服用苯乙双胍70片(25mg/片),1d后出现呕吐、腹痛腹泻、呼吸困难、谵妄、躁动、意识丧失、呼之不应。BP70/39mmHg,HR114次/min。实验室检查:血糖0.06mmol/L,乳酸32.51mmol/L,SCr169μmol/L;pH值6.89,PCO220mmHg,PO271.2mmHg,SaO20.913,BE-19.8mmol/L,HCO3-16.5mmol/L。给予50%葡萄糖注射液40mL静脉推注、5%碳酸氢钠250mL静脉滴注、补液、呼吸机支持、血液滤过等治疗,4d后患者神志转清,恢复自主呼吸,10d后好转出院。

A 24-year-old woman took 70 tablets of phenformin 25 mg. One day later,the patient experienced vomiting,abdominal pain,diarrhea,dyspnea,delirium,agitation,unconsciousness,and no response to voice stimuli. Her blood pressure was 70/39 mm Hg and heart rate was 114 beats/min. The laboratory examinations revealed the following levels and values：glucose 0.06 mmol/L,lactic acid 32.51 mmol/L,SCr 169 μmol/L,pH 6.89,PCO2 20 mm Hg,PO2 71.2 mm Hg,SaO2 0.913,BE-19.8 mmol/L,and HCO3^-16.5 mmol/L. She was given an IV push of 50% glucose 40 mL,and an IV infusion of 5% sodium dicarbonate 250 mL,fluid supplementation,ventilator support,hemofiltration,and other treatments. Four days later,the patient returned to normal consciousness and spontaneous respiration and,10 days later,she recovered and was discharged.