著者

Kazumasa Kotake Akihiro Tahira Yasuhiro Kawakami

出版者

Japanese Society for Clinical Toxicology

雑誌

中毒研究 (ISSN:09143777)

巻号頁・発行日

vol.35, no.3, pp.195-198, 2022-09-10 (Released:2023-01-26)

参考文献数

12

---

絶食時にジスチグミン臭化物を服用したためコリン作動性クリーゼを発症した1例を報告する。症例は89歳,男性。入院1週間前より血便が続いており,血圧低下および意識障害をきたしたため,当院へ緊急搬送された。大腸憩室出血を内視鏡的に止血し,絶食下にてジスチグミン臭化物2.5 mg/dayが再開された。その結果,入院第8病日に意識障害が認められた。薬剤師はジスチグミン臭化物によるコリン作動性クリーゼを疑い,採血結果および身体所見を確認した。その結果,コリンエステラーゼの低値(17 IU/L)および縮瞳(瞳孔径1.5 mm/1.5 mm)が認められたため,主治医にジスチグミン臭化物の中止を提案した。その後は状態が改善し,第20病日退院となった。絶食時のジスチグミン臭化物の服用により,ジスチグミン臭化物の血中濃度が上昇し,コリン作動性クリーゼを発症する可能性があることを念頭に置くべきである。

著者

Kazumasa Kotake Atsuhito Tone Satoko Watanabe Mayumi Senoo Mitsuhiro Kaneto Yusuke Imai Sanae Teshigawara Yasuhiro Kawakami Tatsuaki Nakatou

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.60, no.14, pp.2251-2254, 2021-07-15 (Released:2021-07-15)

参考文献数

20

被引用文献数

2

---

Distigmine bromide is widely used to treat neurogenic bladder and causes cholinergic crisis, a serious side effect. We herein report about a patient with distigmine bromide-induced cholinergic crisis complicated by a hyperosmolar hyperglycemic state (HHS). On admission, the patient was diagnosed with HHS based on the medical history and laboratory test results. However, she also had bradycardia, miosis, and low plasma cholinesterase activity. We later found that she had received distigmine bromide, which led to a diagnosis of cholinergic crisis. We suggest that the exacerbation of pathology, including HHS, can cause cholinergic crisis in patients receiving distigmine bromide.

著者

Kazumasa Kotake Takashi Hongo Akihiro Tahira Nana Niimi Ikue Haisa Yasuhiro Kawakami

出版者

The Pharmaceutical Society of Japan

雑誌

Biological and Pharmaceutical Bulletin (ISSN:09186158)

巻号頁・発行日

vol.44, no.5, pp.605-610, 2021-05-01 (Released:2021-05-01)

参考文献数

36

---

Recombinant human thrombomodulin (rhTM) is an anti-coagulant used to treat disseminated intravascular coagulation (DIC). The efficacy of rhTM in patients with sepsis-induced DIC has been proved in some clinical trials, but the determining factors are not known. The aim of this study was to identify patients for whom rhTM will be effective and the factors that determine rhTM efficacy in alleviating DIC. A single-center, retrospective, observational study was conducted in patients with sepsis-induced DIC who were treated with rhTM in Okayama Saiseikai General Hospital (Okayama, Japan) between January 2010 and December 2019. Among 67 patients who were treated with rhTM, DIC was resolved in 24 patients. The multivariate logistic regression analysis revealed that age (odds ratio (OR) 1.05; 95% confidence interval (CI) 1.00–1.10; p < 0.05) and acute physiology and chronic health evaluation II scores (OR 0.88; 95% CI 0.78–0.98; p < 0.05) were factors that determined rhTM efficacy in alleviating DIC. Overall, our study provides valuable information on factors that should be considered before rhTM administration to patients with sepsis-induced DIC for a better management of healthcare costs.

著者

Kazumasa Kotake Atsuhito Tone Satoko Watanabe Mayumi Senoo Mitsuhiro Kaneto Yusuke Imai Sanae Teshigawara Yasuhiro Kawakami Tatsuaki Nakatou

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.6261-20, (Released:2021-02-15)

参考文献数

20

被引用文献数

2

---

Distigmine bromide is widely used to treat neurogenic bladder and causes cholinergic crisis, a serious side effect. We herein report about a patient with distigmine bromide-induced cholinergic crisis complicated by a hyperosmolar hyperglycemic state (HHS). On admission, the patient was diagnosed with HHS based on the medical history and laboratory test results. However, she also had bradycardia, miosis, and low plasma cholinesterase activity. We later found that she had received distigmine bromide, which led to a diagnosis of cholinergic crisis. We suggest that the exacerbation of pathology, including HHS, can cause cholinergic crisis in patients receiving distigmine bromide.