急性ブロムワレリル尿素中毒の1例―臨床経過と血中濃度の推移

A Case of Acute Bromvalerylurea Intoxication : Clinical Course and Alteration in Serum Bromvalerylurea Concentration

急性意識障害で来院した急性ブロムワレリル尿素中毒の20歳女性例を報告した。見かけ上の高Cl血症は呈さず，bromide rashと呼ばれる皮疹が診断の手がかりとなり，ブロムワレリル尿素血中濃度測定により確定診断にいたった。補液および呼吸管理などの治療開始後，第2病日には血中濃度がさらに致死域にまで上昇した。ブロムワレリル尿素血中濃度の改善とともに意識障害は深昏睡から改善し意識清明となった。経過中に重症肝炎，DICを併発し，更なる加療後に独歩にて退院した。本剤は指定医薬品として医師の処方箋なしで入手が可能であり，急性意識障害の鑑別診断として十分注意を要する。急性ブロムワレリル尿素中毒が疑われた場合，腹部単純写真による薬物塊の有無を確認し，来院までの経過時間とは関係なく胃洗浄を積極的に検討すべきである。

Bromvalerylurea is one of the non-barbiturates products and has been used as analgesics and hypnotics in Japan. A 20-year-old woman was admitted to our hospital for loss of consciousness. She had a 6-month history of transient delirium and drunken gait. Physical examination revealed erythema less than thumb's head size at her face, shoulder and thigh. Neurologically, she had a state of coma and low muscle tonus. EEG showed the pattern of burst-suppression. The level of her serum chloride was not elevated. The erythema made us check up her state of acute bromvalerylurea intoxication. High blood concentration of bromvalerylurea led to diagnosis of the bromvalerylurea intoxication. The maximum value of her serum bromvalerylurea concentration was 107μg/ml on the second hospital day, while the concentration in cerebrospinal fluid were also increased and remained for several days. She was treated with respiration control and drip infusions. She gradually improved and recovered to be alert. She was complicated severe liver dysfunction and disseminated intravascular coagulation resulting from bromvalerylurea intoxication, also treated with intensive care and gradually recovered.

　We should take notice to bromvalerylurea, easily available over the counter, as one of the drugs which may cause severe loss of consciousness or coma, and general complications. And if the bromvalerylurea intoxication is prospective, we should consider whether the option of gastric irrigation is available regardless of the elapsed time.