空腹大量饮酒后服用二甲双胍致乳酸酸中毒

空腹大量饮酒后服用二甲双胍致乳酸酸中毒

周茜;邱峰;龙锐

【期刊名称】《药物不良反应杂志》 【年(卷),期】2017(019)004

【摘要】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