혈액투석 환자에서 메트포르민 복용으로 발생한 급성췌장염과 젖산산증
Metformin induced acute pancreatitis and lactic acidosis in a patient on hemodialysis
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Metformin, commonly prescribed for type 2 diabetes, is considered safe with minimal side-effect. Acute pancreatitis is rare but potentially fatal adverse side-effect of metformin. We report a patient on hemodialysis with metformin-related acute pancreatitis and lactic acidosis. A 62-year-old woman with diabetic nephropathy and hypertension presented with nausea and vomiting for a few weeks, followed by epigastric pain. At home, the therapy of 500 mg/day metformin and 50 mg/day sitagliptin was continued, despite symptoms. Laboratory investigations showed metabolic acidosis with high levels of lactate, amylase at 520 U/L (range, 30-110 U/L), and lipase at 1,250 U/L (range, 23-300 U/L). Acute pancreatitis was confirmed by computed tomography. No recognized cause of acute pancreatitis was identified. Metformin was discontinued. Treatment with insulin and intravenous fluids resulted in normalized amylase, lipase, and lactate. When she was re-exposed to sitagliptin, no symptoms were reported.
Abstract
Metformin, commonly prescribed for type 2 diabetes, is considered safe with minimal side-effect. Acute pancreatitis is rare but potentially fatal adverse side-effect of metformin. We report a patient on hemodialysis with metformin-related acute pancreatitis and lactic acidosis. A 62-year-old woman with diabetic nephropathy and hypertension presented with nausea and vomiting for a few weeks, followed by epigastric pain. At home, the therapy of 500 mg/day metformin and 50 mg/day sitagliptin was continued, despite symptoms. Laboratory investigations showed metabolic acidosis with high levels of lactate, amylase at 520 U/L (range, 30-110 U/L), and lipase at 1,250 U/L (range, 23-300 U/L). Acute pancreatitis was confirmed by computed tomography. No recognized cause of acute pancreatitis was identified. Metformin was discontinued. Treatment with insulin and intravenous fluids resulted in normalized amylase, lipase, and lactate. When she was re-exposed to sitagliptin, no symptoms were reported.
참고문헌 (11)
- Dell’Aglio DM, "Acute metformin overdose: examining serum pH, lactate level, and metformin concentrations in survivors versus nonsurvivors: a systematic review of the literature", Ann Emerg Med, 54, pp.818~823 (2009)
- Lalau JD., "Lactic acidosis induced by metformin: incidence, management and prevention", Drug Saf, 33, pp.727~740 (2010)
- Alsubaie S, "Metformin induced acute pancreatitis", Dermatoendocrinol, 5, pp.317~318 (2013)
- Bailey CJ, "Metformin", N Engl J Med, 334, pp.574~579 (1996)
- Lipska KJ, "Use of metformin in the setting of mild-to-moderate renal insufficiency", Diabetes Care, 34, pp.1431~1437 (2011)
- Nelson M, "Sitagliptin-induced pancreatitis - a longer road than expected", Clin Case Rep, 2, pp.149~152 (2014)
- Frossard JL, "Acute pancreatitis", Lancet, 371(9607), pp.143~152 (2008)
- Moreno Escobosa MC, "Pancreatitis due to codeine", Allergol Immunopathol (Madr), 33, pp.175~177 (2005)
- Floyd A, "Risk of acute pancreatitis in users of azathioprine:a population-based case-control study", Am J Gastroenterol, 98, pp.1305~1308 (2003)
- Sampanis Ch., "Management of hyperglycemia in patients with diabetes mellitus and chronic renal failure", Hippokratia, 12, pp.22~27 (2008)
- Iglesias P, "Insulin therapy in renal disease", Diabetes Obes Metab, 10, pp.811~823 (2008)