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要旨 症例は,排尿障害に対して約2年前から distigmine bromide を服用していた73歳男性である。急性膀胱炎の治療中に意識障害を呈し,入院した。著明な縮瞳と下痢,徐脈傾向などコリン刺激症状の存在と血清コリンエステラーゼ(ChE)活性の著明な低下を認め,distigmine bromide の急性中毒と診断した。腎機能障害の急性増悪が急性中毒の誘引と考えられた。服薬中止により症状,血清ChE活性とも速やかに改善した。近年,重症筋無力症の治療として本剤を高用量で使用する機会が減り,急性中毒の発症はきわめて稀となった。一方,本剤は排尿障害の治療に広く使用されているが,本症例のように常用量を長期間服用している例においても突然,急性中毒を生じる可能性がある。高齢者の意識障害の原因として,本剤による急性中毒の可能性も念頭におき,服薬歴やコリン刺激症状の存在に留意する必要がある。
Distigmine bromide(Ubretid(R)) is a long-acting anticholinesterase, widely used for the treatment of underactive neurogenic bladder and myasthenia gravis. Our study concerns a 73-year-old man treated with a potentially life-threatening cholinergic state due to distigmine bromide. He had been administered distigmine bromide orally for over two years at a daily dosage of 10mg as a treatment for underactive neurogenic bladder. He suddenly developed diarrhea and consciousness disturbance during treatment of his urinary tract infection. Bradycardia and miosis were noted. Blood examination revealed extremely low levels of the plasma cholinesterase activity. The condition was diagnosed as distigmine bromide intoxication. All cholinergic symptoms disappeared in several days after the administration of distigmine bromide was terminated. Cholinergic crisis due to overdosage with anticholinesterases is well known, and the myasthenic patients are usually supervised in the early stages of dosage regulation to guard against the possibility of cholinergic crisis. However the use of oral distigmine bromide, even in therapeutic doses for urinary retention, could result in cholinergic crisis. We therefore conclude that extreme caution must be used in administering distigmine bromide.
(Received : November 6, 2003)
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