常用量のジスチグミンによるコリン作動性クリーゼ

概要

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排尿困難に対して、コリンエステラーゼ阻害薬であるジスチグミンが古くから用いられている。今回、常用量のジスチグミンを4回内服したのみで、コリン作動性クリーゼからショック状態に陥った症例を経験したので、若干の文献的考察を加えて報告する。Distigmine bromide is an anticholinesterase used to treat urinary retention. We describe a case of life-threateningcholinergic crisis induced by a usual oral dose of distigmine bromide for postoperative urinary retention.An 82-year-old man with mild chronic renal failure was transferred to our emergency room due to cholinergiccrisis accompanied by cyanosis, hypotension, and consciousness disturbance. The patient was 10mg/day of distigminebromide orally administered for 2 days. The patient's serum cholinesterase decreased to 3IU/l.Mechanical ventilation, fluid resuscitation, and inotropic support were started. A few days after admission,despite continuous low serum cholinesterase, his toxic symptoms almost disappeared. Extubation was done, andthe patient had an event-free recovery. The possibility of cholinergic crisis should be considered when patientswith renal failure are given distigmine bromide. During cholinergic crisis, toxic symptoms do not parallel serumcholinesterase. Cholinergic crisis should thus be treated while carefully observing clinical symptoms.
日本救急医学会の論文