二甲双胍相关乳酸酸中毒和血糖酮症酸中毒同时发生的罕见病例

IF 0.4 Q3 MEDICINE, GENERAL & INTERNAL Proceedings of Singapore Healthcare Pub Date : 2023-09-27 DOI:10.1177/20101058231204703
Geraldine Pei Yi Koo, Aliviya Dutta, Yuan Helen Zhang
{"title":"二甲双胍相关乳酸酸中毒和血糖酮症酸中毒同时发生的罕见病例","authors":"Geraldine Pei Yi Koo, Aliviya Dutta, Yuan Helen Zhang","doi":"10.1177/20101058231204703","DOIUrl":null,"url":null,"abstract":"Metformin-associated lactic acidosis (MALA) and euglycaemic diabetic ketoacidosis (EKA) are both life-threatening endocrine emergencies. MALA is a well-documented complication of anti-glycaemic therapy in diabetics while EKA is an increasingly recognized disease entity with the advent of use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors. However, the occurrence of concurrent metformin-associated lactic acidosis and euglycaemic ketoacidosis (MALKA) is uncommon and rarely reported in the literature. We report an unusual case of MALKA, in a 74-year-old gentleman with no previous history of chronic kidney disease and SGLT-2 inhibitor use, who presented with altered mental status, acute renal failure and profound high anion-gap metabolic acidosis (HAGMA) with lactaemia, ketonaemia and normoglycaemia (pH 6.965, bicarbonate 3.1, creatinine 522, glucose 6.6, lactate 17.5, ketones >8). The patient was initiated on intravenous insulin infusion with dextrose-containing drip and continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). The patient had a prolonged hospital stay but was eventually discharged with a normalised renal function without need for long-term dialysis. The parallel occurrence of MALA and EKA suggest a metformin-associated inhibition of gluconeogenesis. This case highlights the importance of early recognition and investigation of concurrent diabetic ketoacidosis in the presence of MALA and vice versa as MALKA benefits from both prompt institution of parenteral glucose therapy and insulin infusion and consideration of initiation of haemodialysis.","PeriodicalId":44685,"journal":{"name":"Proceedings of Singapore Healthcare","volume":null,"pages":null},"PeriodicalIF":0.4000,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Unusual case of concurrent metformin-associated lactic acidosis and euglycaemic ketoacidosis\",\"authors\":\"Geraldine Pei Yi Koo, Aliviya Dutta, Yuan Helen Zhang\",\"doi\":\"10.1177/20101058231204703\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Metformin-associated lactic acidosis (MALA) and euglycaemic diabetic ketoacidosis (EKA) are both life-threatening endocrine emergencies. MALA is a well-documented complication of anti-glycaemic therapy in diabetics while EKA is an increasingly recognized disease entity with the advent of use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors. However, the occurrence of concurrent metformin-associated lactic acidosis and euglycaemic ketoacidosis (MALKA) is uncommon and rarely reported in the literature. We report an unusual case of MALKA, in a 74-year-old gentleman with no previous history of chronic kidney disease and SGLT-2 inhibitor use, who presented with altered mental status, acute renal failure and profound high anion-gap metabolic acidosis (HAGMA) with lactaemia, ketonaemia and normoglycaemia (pH 6.965, bicarbonate 3.1, creatinine 522, glucose 6.6, lactate 17.5, ketones >8). The patient was initiated on intravenous insulin infusion with dextrose-containing drip and continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). The patient had a prolonged hospital stay but was eventually discharged with a normalised renal function without need for long-term dialysis. The parallel occurrence of MALA and EKA suggest a metformin-associated inhibition of gluconeogenesis. This case highlights the importance of early recognition and investigation of concurrent diabetic ketoacidosis in the presence of MALA and vice versa as MALKA benefits from both prompt institution of parenteral glucose therapy and insulin infusion and consideration of initiation of haemodialysis.\",\"PeriodicalId\":44685,\"journal\":{\"name\":\"Proceedings of Singapore Healthcare\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.4000,\"publicationDate\":\"2023-09-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Proceedings of Singapore Healthcare\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/20101058231204703\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Proceedings of Singapore Healthcare","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/20101058231204703","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

摘要

二甲双胍相关性乳酸酸中毒(MALA)和糖尿病酮症酸中毒(EKA)都是危及生命的内分泌急症。MALA是糖尿病患者降糖治疗的并发症,而EKA随着钠-葡萄糖共转运体-2 (SGLT-2)抑制剂的使用越来越被认可。然而,二甲双胍相关乳酸酸中毒和血糖酮症酸中毒(MALKA)的并发发生并不常见,文献中很少报道。我们报告一例不寻常的MALKA病例,患者为74岁男性,既往无慢性肾脏疾病史,无SGLT-2抑制剂使用史,表现为精神状态改变、急性肾功能衰竭和重度高阴离子间隙代谢性酸中毒(HAGMA),伴有乳酸血症、酮血症和正常血糖(pH 6.965、碳酸氢盐3.1、肌酐522、葡萄糖6.6、乳酸17.5、酮类8)。患者在重症监护室(ICU)开始静脉滴注葡萄糖胰岛素和持续肾脏替代治疗(CRRT)。患者住院时间延长,但最终出院时肾功能恢复正常,无需长期透析。MALA和EKA的平行发生提示二甲双胍相关的糖异生抑制。该病例强调了早期识别和调查MALA并发糖尿病酮症酸中毒的重要性,反之亦然,因为MALKA受益于及时的肠外葡萄糖治疗和胰岛素输注,并考虑开始血液透析。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Unusual case of concurrent metformin-associated lactic acidosis and euglycaemic ketoacidosis
Metformin-associated lactic acidosis (MALA) and euglycaemic diabetic ketoacidosis (EKA) are both life-threatening endocrine emergencies. MALA is a well-documented complication of anti-glycaemic therapy in diabetics while EKA is an increasingly recognized disease entity with the advent of use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors. However, the occurrence of concurrent metformin-associated lactic acidosis and euglycaemic ketoacidosis (MALKA) is uncommon and rarely reported in the literature. We report an unusual case of MALKA, in a 74-year-old gentleman with no previous history of chronic kidney disease and SGLT-2 inhibitor use, who presented with altered mental status, acute renal failure and profound high anion-gap metabolic acidosis (HAGMA) with lactaemia, ketonaemia and normoglycaemia (pH 6.965, bicarbonate 3.1, creatinine 522, glucose 6.6, lactate 17.5, ketones >8). The patient was initiated on intravenous insulin infusion with dextrose-containing drip and continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). The patient had a prolonged hospital stay but was eventually discharged with a normalised renal function without need for long-term dialysis. The parallel occurrence of MALA and EKA suggest a metformin-associated inhibition of gluconeogenesis. This case highlights the importance of early recognition and investigation of concurrent diabetic ketoacidosis in the presence of MALA and vice versa as MALKA benefits from both prompt institution of parenteral glucose therapy and insulin infusion and consideration of initiation of haemodialysis.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Proceedings of Singapore Healthcare
Proceedings of Singapore Healthcare MEDICINE, GENERAL & INTERNAL-
CiteScore
0.90
自引率
0.00%
发文量
42
审稿时长
15 weeks
期刊最新文献
Caudal epidural, pericapsular nerve group block and lateral femoral cutaneous nerve block in hip fracture surgery: A case report Assessment and evaluation of nutrition education among physicians in a tertiary paediatric specialist hospital: The need for improved clinical nutrition teaching Heat-related illness in Singapore: Descriptive analysis of a tertiary care center from 2008 to 2020 A review on cytomegalovirus in patients with autoimmune inflammatory rheumatic diseases: Prevalence, clinical spectrum, treatment, and antiviral prophylaxis Ophthalmic primary care in Singapore: Considerations for review
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1