空腹大量饮酒后服用二甲双胍致乳酸酸中毒

Lactic acidosis induced by metformin and a large amount of alcohol drinking into an empty stomach

1例61岁男性2型糖尿病患者空腹饮52度白酒约400 ml后约30 min服用二甲双胍850 mg,约4 h后出现剑突下闷痛不适、心悸,约7 h后出现恶心及呕吐.实验室检查示血pH 7.16,乳酸15.0 mmol/L,剩余碱-12.6 mmol/L,碳酸氢盐 15 mmol/L,诊断为糖尿病乳酸酸中毒.给予吸氧、纠正酸中毒、补液等综合对症支持治疗,并停用二甲双胍,改为罗格列酮4 mg口服、1次/d.18 h后患者剑突下闷痛明显减轻,未再出现恶心、呕吐,复查示血pH 7.41,乳酸1.8 mmol/L,剩余碱2.3 mmol/L,碳酸氢盐27 mmol/L.

A 61-year-old male patient with type 2 diabetes received an oral metformin 850 mg about 30 minutes after drinking about 400 ml liquor containing 52% of alcohol into an empty stomach.About 4 hours later, the patient developed stuffy pain below xiphoid process and palpitation, and about 7 hous later, he developed nausea and vomiting.The laboratory examination showed that the blood pH 7.16, lactic acid 15.0 mmol/L, base excess-12.6 mmol/L, bicarbonate 15 mmol/L.He was diagnosed as diabetic lactic acidosis.Comprehensive treatments such as oxygen inhalation, acidosis correction, fluid infusion were given and metformin was changed to oral rosiglitazone 4 mg once daily.Eighteen hours later, the discomfort below xiphoid process was markedly improved, nausea and vomiting did not recur, his laboratory examination results showed the blood pH 7.41, lactic acid 1.8 mmol/L, base excess 2.3 mmol/L, and bicarbonate 27 mmol/L.