PDF(Pubmed)
Abstract：
Metformin-associated lactic acidosis (MALA) is a serious condition with high mortality. This case describes a man in the mid-60s with diabetes mellitus type 2 treated with metformin developing MALA 4 days after coronary stenting for non-ST-elevation myocardial infarction. He presented acutely with severe abdominal pain, a lactate of 19 mmol/L and pH 6.74. Despite treatment for MALA, he went into refractory cardiac arrest and was connected to venoarterial extracorporeal membrane oxygenation (VA-ECMO). He suffered a massive haemothorax due to perforation of the right atrial appendage. It was repaired through a sternotomy while being given massive blood transfusions. The following days, he was on VA-ECMO and double continuous venovenous haemodialysis (CVVHD). He survived with only mild paresis of the left hand. VA-ECMO should be considered a rescue therapy alongside treatment with CVVHD in case of cardiac arrest due to severe MALA.
摘要：
二甲双胍相关性乳酸性酸中毒（MALA）是一种严重的疾病，死亡率很高。该病例描述了一名60多岁的2型糖尿病患者，在冠状动脉支架置入治疗非ST段抬高型心肌梗死后4天，接受二甲双胍治疗的MALA。他出现了剧烈的腹痛，乳酸19mmol/L和pH6.74。尽管对MALA进行了治疗，患者进入难治性心脏骤停,并与静脉动脉体外膜氧合(VA-ECMO)连接.由于右心耳穿孔，他遭受了大量的血胸。它是通过胸骨切开术修复的，同时进行了大量输血。接下来的日子,患者接受VA-ECMO和双连续性静脉-静脉血液透析(CVVHD).他幸免于难，左手只有轻度轻瘫。在严重MALA引起的心脏骤停的情况下，应考虑将VA-ECMO与CVVHD一起治疗。
