臨牀透析 Vol.18 No.8(2-3-1)


特集名 薬物・毒物中毒と血液浄化法(症例集)
題名 [中毒症例]III. 医薬品 (1) 催眠鎮静剤(フェノバルビタール・アセトアミノフェン)
発刊年月 2002年 07月
著者 横山 隆 札幌徳洲会病院腎臓内科
【 要旨 】 急性フェノバルビタール・アセトアミノフェン中毒での血液浄化法の適応に関して検討した.フェノバルビタール中毒では補液とくに尿のアルカリ化療法が有効であるが,症状が重篤なときや血中濃度が致死量に達した症例では血液浄化の適応となる.第一選択は血液灌流であるが,浄化後の血小板減少を伴わず,電解質補正や除水の必要な例では血液透析も有用である.アセトアミノフェン中毒では肝毒性発現防止のためN-アセチルシステイン製剤が有用である.本剤は体内代謝が速く,中毒量以上を服用した患者の血中濃度の推移を検討した結果,血液浄化を必要とする症例はきわめて少ないものと思われた.
Theme Intoxication of Drugs and Poisons and Blood Purification Therapy (Case Report)
Title Phenobarbital and acetaminophen poisoning
Author Takashi Yokoyama Department of Nephrology, Sapporo Tokushukai Hospital
[ Summary ] Indications for performing blood purification in patients with phenobarbital or acetaminophen poisoning were retrospectively analized. Most patients having drug overdoses can be adequately treated with general supportive care, cathartics, and activated charcoal. Forced alkaline diuresis is generally effective for phenobarbital intoxication. In severely compromised patients, with high serum phenobar bital levels, both hemodialysis and direct hemoperfusion were quite effective. The procedure was associated with a rapid fall in serum levels and a dramatic improvement in patient's clinical condition. On the contrary, in cases of acetaminophen poisoning, N-acetyl cysteine antidotal therapy is the standard treatment in order to prevent hepatic injury. Though a few cases, presenting the effectiveness of hemodialysis or hemoperfusion have been previously reported, extracorporeal therapy is not necessary for most patients with acetaminophen poisoning because of it's rapid metabolism.
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