医学
体外膜肺氧合
乳酸性酸中毒
肾脏替代疗法
心肌梗塞
二甲双胍
心脏病学
麻醉
内科学
胰岛素
作者
Kirstine Krushave Akkaoui,Ljubica Vukelic Andersen,Martin Agge Nørgaard,Jo Bønding Andreasen
出处
期刊:Case Reports
[BMJ]
日期:2023-08-01
卷期号:16 (8): e254649-e254649
标识
DOI:10.1136/bcr-2023-254649
摘要
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.
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