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간신증후군으로 오인하였던 메포르민에 의한 유산산증 1예

A Case of Metformin-Induced Lactic Acidosis with Acute Kidney Injury Misdiagnosed as Hepatorenal Syndrome in a Cirrhosis Patient

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초록

저자들은 간경화 환자에서 메포르민에 의해 발생한 유산산증 및 급성 신손상 환자를 약물 복용력이 확인되지 않아 간신증후군으로 오진하였던 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Abstract

Metformin is a well-established drug for the treatment of type 2 diabetes mellitus. The incidence of metformin-induced lactic acidosis is low, but the estimated mortality rate is approximately 50% in cases with lactic acidosis in combination with metformin therapy. Lactic acidosis occurs most often in patients with compromised cardiac, pulmonary, hepatic, and/or renal function. Acute kidney injury is a relatively frequent problem in cirrhosis patients. Hepatorenal syndrome is a diagnosis of exclusion, making its diagnosis difficult in the clinical field. We report a case of metformin-induced lactic acidosis with acute kidney injury that was misdiagnosed as hepatorenal syndrome in a cirrhosis patient. (Korean J Med 2012;82:241-246)

참고문헌 (10)

  1. 강병일, "혈액투석으로 성공적으로 치료한 메포르민 유산산증 2예", 대한내과학회지, 80(4), pp.473~476 (2011), 대한내과학회
  2. Herrington WG, "Metformin: effective and safe in renal disease?", Int Urol Nephrol, 40, pp.411~417 (2008)
  3. 최혜숙, "메포르민사용에 의한 유산산증(Lactic Acidosis) 1예", Kidney Research and Clinical Practice, 23(1), pp.143~146 (2004), 대한신장학회
  4. Garcia-Tsao G, "Acute kidney injury in cirrhosis", Hepatology, 48, pp.2064~2077 (2008)
  5. Suh YS., "Extrahepatic Disorder in Portal Hypertension : Kidney: Hepatorenal syndrome type 1 and 2", Korean J Hepatol, 15, pp.69~83 (2009)
  6. Forsythe SM, "Sodium bicarbonate for the treatment of lactic acidosis", Chest, 117, pp.260~267 (2000)
  7. Bruijstens LA, "Reality of severe metformin-induced lactic acidosis in the absence of chronic renal impairment", Neth J Med, 66, pp.185~190 (2008)
  8. 곽진호, "지속적 정정맥 혈액여과투석을 이용하여 성공적으로 치료한 중증 유산산증 3예", Kidney Research and Clinical Practice, 25(4), pp.661~668 (2006), 대한신장학회
  9. Peters N, "Metformin-associated lactic acidosis in an intensive care unit", Crit Care, 12, pp.149~ (2008)
  10. Calabrese AT, "Evaluation of prescribing practices: risk of lactic acidosis with metformin therapy", Arch Intern Med, 162, pp.434~437 (2002)

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