砒素入り醤油中毒の臨床

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This is a clinical report on an outbreak of an acute arsenic poisoning due to soy-sauce accidentally contaminated by arsenic, which occurred among a population of the City of Ube, Yamaguchi Prefecture, in January 1956. The main symptoms observed in 220 cases out of the total 417 patients were edema of the face, gastrointestinal and upper respiratory symptoms followed by skin lesions and neuritic signs which occurred in a limited number of patients in the late stage. In the majority of patients, the symptoms appeared 2 days after the intake of arsenic and subsided gradually after the 5th or 6th day of illuess, despite continuous intake of the poison. Those symptoms disappeared rapidly after two weeks when the patients ceased taking arsenic, except neuropathy such as abnormal patellar reflex and tenderness in the calf muscle which were aggravated afterwards.The liver was palpated for one or two finger breadths in most of the cases, and decreased in size after the symptoms subsided. Electrocardiogram revealed abnormalities in Q-T interval and P- and T-waves. Ophthalmoiogically, conjunctivitis, central scotoma and neuro-retinitis were detected.Laboratory data indicated; slight anemia, leukopenia, relative lymphocytosis, positive urine urobilinogen in 60 to 80% of the cases, normal electrolytes and ureaclearance. Fecal occult blood was positive in many of the patients, and in some, occult blood was demonstrable in gastric and duodenal juice. Chemical analysis of serum was suggestive of slight involvement of the liver, whereas the biopsy revealed slight but definite degenerative changes such as decrease of nucleic acid in liver cells. Liver detoxifying function was impaired in about half of the cases, but BSP test remained normal.Arsenic was demonstrated in the urine in an appreciable concentration even two weeks after the suspension of arsenic ingestion. A low concentration of arsenic was also detected in both gastric and duodenal juice. The root portion of the hair contained more arsenic than the rest of the hair.The duration of arsenic ingestion was two or three weeks in most of the cases, and arsenic content of the soy-sauce which caused this accident was estimated to be about 0.1mg per milliliter. (The English original report will be presented in the Bulletin of the Yamaguchi Medical School.)
社団法人日本内科学会の論文

砒素入り醤油中毒の臨床

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