Two Cases of Metformin-Induced Lactic Acidosis Successfully Treated by Hemodialysis

혈액투석으로 성공적으로 치료한 메포르민 유산산증 2예

  • Kang, Byung-Il (Department of Internal Medicine, Soonchunhyang University Hospital) ;
  • Kim, Su-Ji (Department of Internal Medicine, Soonchunhyang University Hospital) ;
  • Kim, Jung-Hoon (Department of Internal Medicine, Soonchunhyang University Hospital) ;
  • Gil, Hyo-Wook (Department of Internal Medicine, Soonchunhyang University Hospital) ;
  • Yang, Jong-Oh (Department of Internal Medicine, Soonchunhyang University Hospital) ;
  • Lee, Eun-Young (Department of Internal Medicine, Soonchunhyang University Hospital) ;
  • Hong, Sae-Yong (Department of Internal Medicine, Soonchunhyang University Hospital)
  • 강병일 (순천향대학교 천안병원 내과학교실) ;
  • 김수지 (순천향대학교 천안병원 내과학교실) ;
  • 김정훈 (순천향대학교 천안병원 내과학교실) ;
  • 길효욱 (순천향대학교 천안병원 내과학교실) ;
  • 양종오 (순천향대학교 천안병원 내과학교실) ;
  • 이은영 (순천향대학교 천안병원 내과학교실) ;
  • 홍세용 (순천향대학교 천안병원 내과학교실)
  • Published : 2011.04.01

Abstract

Metformin-induced lactic acidosis is a rare life-threatening complication associated with metformin treatment and has a high mortality rate. Here, two cases of metformin-induced lactic acidosis are reported. A 22-year-old woman was admitted to our hospital with a metformin overdose (25 g) and lactic acidosis. Hemodialysis was initiated to correct the acidemia, and the patient showed full recovery. Her serum creatinine level returned to normal. A 50-year-old man presented with a 5-day history of muscle weakness. His medical history included diabetes mellitus for 6 years treated with metformin at 3,000 mg/day and hypertension. An arterial blood sample showed metabolic acidosis, with a venous lactate level of 31.1 mg/dL. The patient recovered fully after treatment with bicarbonate dialysis. These cases illustrate that the presence of clinical conditions such as renal failure increase the risk of metformin-induced lactic acidosis. Prompt recognition of lactic acidosis and early treatment with bicarbonate dialysis can result in a successful clinical outcome.

저자들은 자살목적으로 과량의 메포르민 음독 후에 발생한 유산산증과 신기능 저하상태에서 지속적으로 복용 중 발생한 유산산증을 혈액투석을 통해 성공적으로 치료된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. 심미령, 양봉준, 임종주 등. Metformin복용중인 당뇨병 노인에서 발생한 유산혈증 1예. 원광의과학 2003;18:95-100.
  2. 박정숙, 김의중, 정성필, 이한식. Metformin 과다 복용에 의한 대사성 젖산 산증 1례. 대한임상독성학회지 2007;5:126-130.
  3. 김보인, 정진희, 어은경. 혈당 강하제 metformin 중독 후 발생한 심각한 산혈증 1례. 대한임상독성학회지 2008;6:42-44.
  4. Price G. Metformin lactic acidosis, acute renal failure and rofecoxib. Br J Anaesth 2003;91:909-910. https://doi.org/10.1093/bja/aeg255
  5. 최혜숙, 정경환, 심재준 등. 메포르민사용에 의한 유산산증 (Lactic Acidosis) 1예. 대한신장학회지 2004;23:143-146.
  6. Alivanis P, Giannikouris I, Paliuras C, Arvanitis A, Volanaki M, Zervos A. Metformin-associated lactic acidosis treated with continuous renal replacement therapy. Clin Ther 2006;28:396-400. https://doi.org/10.1016/j.clinthera.2006.03.004
  7. 강병승, 김혜원, 김명현 등. 고의적 metformin 과복용 후 발생한 중증 유산 산증 치험 1예. 대한내과학회지 2008;75:894-897.
  8. Dell'Aglio DM, Perino LJ, Kazzi Z, Abramson J, Schwartz MD, Morgan BW. Acute metformin overdose: examining serum pH, lactate level and metformin concentration in survivors versus nonsurvivors: a systematic review of the literature. Ann Emerg Med 2009;54:818-823. https://doi.org/10.1016/j.annemergmed.2009.04.023
  9. 봉종대, 곽상혁, 부귀범, 심두선, 이태웅. 메트폴민과 연관된 유산소증에 의한 급성 신부전을 보인 노인 당뇨환자를 통한 조기진단과 혈액투석의 중요성. 노인병 2004;8:115-118.
  10. Adams BD, Bonzani TA, Hunter CJ. The anion gap does not accurately screen for lactic acidosis in emergency department patients. Emerg Med J 2006;23:179-182. https://doi.org/10.1136/emj.2005.026096