Oxygen consumption is depressed in patients with lactic acidosis due to biguanide intoxication 英文参考文献.docVIP

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Oxygen consumption is depressed in patients with lactic acidosis due to biguanide intoxication 英文参考文献.doc

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Oxygen consumption is depressed in patients with lactic acidosis due to biguanide intoxication 英文参考文献

Protti et al. Critical Care 2010, 14:R22 /content/14/1/R22 RESEARCH Open Access Oxygen consumption is depressed in patients with Research lactic acidosis due to biguanide intoxication Alessandro Protti*1, Riccarda Russo1, Paola Tagliabue2, Sarah Vecchio3, Mervyn Singer4, Alain Rudiger5, Giuseppe Foti2, Anna Rossi6, Giovanni Mistraletti7 and Luciano Gattinoni1 Abstract Introduction: Lactic acidosis can develop during biguanide (metformin and phenformin) intoxication, possibly as a consequence of mitochondrial dysfunction. To verify this hypothesis, we investigated whether body oxygen consumption (VO2), that primarily depends on mitochondrial respiration, is depressed in patients with biguanide intoxication. Methods: Multicentre retrospective analysis of data collected from 24 patients with lactic acidosis (pH 6.93 ± 0 .20 ; lactate 18 ± 6 mM at hospital admission) due to metformin (n = 23) or phenformin (n = 1) intoxication. In 11 patients, VO2 was computed as the product of simultaneously recorded arterio-venous difference in O2 content [C(a-v)O2] and cardiac index (CI). In 13 additional cases, C(a-v)O2, but not CI, was available. Results: On day 1, VO2 was markedly depressed (67 ± 28 ml/min/m2) despite a normal CI (3.4 ± 1.2 L/min/m2). C(a-v)O2 was abnormally low in both patients either with (2.0 ± 1.0 ml O2/10 0 ml) or without (2.5 ± 1.1 ml O2/10 0 ml) CI (and VO2) monitoring. Clearance of the accumulated drug was associated with the resolution of lactic acidosis and a parallel increase in VO2 (P 0 .0 0 1) and C(a-v)O2 (P 0 .0 5). Plasma lactate and VO2 were inversely correlated (R2 0 .43; P 0 .0 0 1, n = 32). Conclusions: VO2 is abnormally low in patients with lactic acidosis due to biguanide intoxication. This finding is in line with the hypothesis of inhibited mitochondrial respiration and consequent hyperlactatemia. Introduction Metformin and phenformin are oral anti-diabetic drugs of the Poison Control Centre of Pavia,