著者

佐藤 慧 丹保 亜希仁 奥田 勝博 清水 惠子 南波 仁 一宮 尚裕 山蔭 道明

出版者

一般社団法人 日本集中治療医学会

雑誌

日本集中治療医学会雑誌 (ISSN:13407988)

巻号頁・発行日

vol.28, no.5, pp.454-457, 2021-09-01 (Released:2021-09-01)

参考文献数

10

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要約:急性カフェイン中毒は用量依存性の反応を示し,同じくキサンチン誘導体であるテオフィリン中毒に症状や機序が類似する。致死量の急性カフェイン中毒に対して血液透析(hemodialysis, HD)を施行して改善を認めた症例を経験し,経過中のカフェインおよび中間代謝産物のテオフィリン血中濃度の推移から治療戦略について検討した。本症例のカフェインとテオフィリンの血中濃度は,内服後早期で異なった推移を示した。HD施行後,腸管再吸収に伴うカフェイン血中濃度再上昇時も含め,両者は相似的に推移した。HD効果によるカフェイン血中濃度低下の指標や,再吸収による血中濃度再上昇の指標として,テオフィリン血中濃度の推移は参考となる可能性が示唆された。

著者

石間 巧 南波 仁 清水 斎 角田 一真

出版者

Japanese Association for Acute Medicine

雑誌

日本救急医学会雑誌 (ISSN:0915924X)

巻号頁・発行日

vol.3, no.1, pp.12-15, 1992-02-15 (Released:2009-03-27)

参考文献数

17

被引用文献数

1

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We report a case of rhabdomyolysis complicated by acute renal failure caused by loss of consciousness after drinking. A 46-year-old man fell asleep in his living room after drinking beer and whisky. Showing no signs of awakening by 10 a.m. the next morning, he was transferred to our emergency center. On admission his consciousness level was II-30 (Japan coma scale), and his temperature was 31.1°C. Laboratory data showed hypoglycemia; mixed acidosis; and elevation of CPK, GOT and LDH. The serum ethanol concentration was 221mg/dl. At the midnight on the first hospital day, swelling of the right hip area develope and it declined to be growing. The patient's consciousness gradually returned, however, he remained oliguric despite treatment with fluid challenge and diuretics. A diagnosis of rhabdomyolysis complicated by acute renal failure was made, and hemodialysis was performed. A triacetate membrane was selected as the dialyzer in order to eliminate serum myoglobin. The acute renal failure improved after hemodialysis 20 times in 38 days. The cause of the rhabdomyolysis is believed to have been pressure necrosis due to immobility for many hours in addition to muscle damage caused by ethanol. Hemodialysis with a triacetate membrane was useful in eliminating myoglobin in acute renal failure caused by rhabdomyolysis.