ブホルミンによる重篤な乳酸アシドーシスの1症例  [in Japanese] Lactic acidosis in a diabetic treated with buformin  [in Japanese]

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Abstract

49歳の男性がブホルミン製剤の内服を開始して3日目に腹痛と全身倦怠感を主訴に来院し,血液検査で高カリウム血症(K<sup>+</sup>9.1mmol・<i>l</i><sup>-1</sup>)と乳酸アシドーシス(pH6.84,乳酸値18.2mmol・<i>l</i><sup>-1</sup>,BE-31.5mmol・<i>l</i><sup>-1</sup>)が明らかとなった。2回の血液透析と持続血液濾過透析を施行した結果,乳酸アシドーシスと高カリウム血症は改善し,患者は後遺症を残さず退院した。ブホルミンなどのビグアナイド系経口血糖降下薬はまれに乳酸アシドーシスを引き起こすことがある。乳酸アシドーシスに対する確立された治療法はなくその予後は未だに悪いが,最近になり血液浄化法が奏効した症例が複数報告されている。本症例の乳酸アシドーシスでも血液浄化法が有効であった。血液浄化法は,アシドーシスや電解質異常を補正するだけでなく,原因であるビグアナイド薬を除去できるため,ビグアナイド薬による乳酸アシドーシスに対して有効であると考えられる。

Lactic acidosis in diabetics on biguanide therapy is rare but associated with poor prognosis. We report here a case of buformin-associated lactic acidosis successfully treated with hemodialysis (HD) and continuous hemodiafiltration (CHDF). A 49-year-old man with diabetes mellitus presented himself to the emergency room complaining of abdominal pain and general fatigue. He had begun taking buformin three days before. Initial investigations revealed severe hyperkalemia (K<sup>+</sup>9.1mmol·<i>l</i><sup>-1</sup>) and lactic acidosis (pH6.84, BE-31.5mmol·<i>l</i><sup>-1</sup>, Lactate 18.2mmol·<i>l</i><sup>-1</sup>). He was transferred to the ICU where he underwent two sessions of HD and CHDF. On the third hospital day the patient's condition stabilized and CHDF was discontinued. He was discharged from the ICU on the 6th hospital day. We suggest that hemopurification is the treatment of choice for buformin-associated lactic acidosis, since it not only corrects acid-base disorders, but also may remove buformin.

Journal

  • Journal of the Japanese Society of Intensive Care Medicine

    Journal of the Japanese Society of Intensive Care Medicine 11(3), 207-210, 2004-07-01

    The Japanese Society of Intensive Care Medicine

References:  10

Cited by:  1

Codes

  • NII Article ID (NAID)
    10013517112
  • NII NACSIS-CAT ID (NCID)
    AN10474053
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13407988
  • Data Source
    CJP  CJPref  J-STAGE 
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