Metoclopramide投与により発症し，髄液乳酸高値を呈した悪性症候群の一例

A Case of Metoclopramide-Induced Neuroleptic Malignant Syndrome with Cerebrospinal Fluid Lactic Acidosis

　metoclopralnide（Primperan^®）が関与したと考えられる悪性症候群の症例を報告した。症例は44歳の女性。悪心・嘔吐に対し，metoclopramide 30mgを経静脈的に投与され，13時間後に意識障害，筋固縮，発汗，高熱が生じた。併用されたcimetidineやhydroxyzine pamoateの影響も考えられた。血液生化学上はCPK（アイソザイムは100％骨格筋分画），LDH，ミオグロビン等の筋原性の酵素が上昇していた。保存的治療により，意識障害は第4病日より改善し，第10病日以降には平熱となった。脳脊髄液は著明な乳酸アシドーシス（3.43mmol/l）を呈し，著明な脳内代謝異常が存在したことが示された。

　A case of metoclopramide-induced neuroleptic malignant syndrome with cerebrospinal fluid (CSF) lactic acidosis was reported. A 44-year-old Japanese woman noted tarry stool on July 2, 1988 and was treated with metoclopramide andcimetidine for nausea and vomiting. Hydroxyzine pamoate was also administered for insomnia at 3 : 10 am and she became comatose with muscle rigidity at 3 : 40-4 : 30 am on July 3. Tachycardia and high fever (39.5℃) were evident at 8 : 00 am on July 4. She was transferred to the Kyushu University Hospital. On admission, serum creatine kinase was elevated to 1640 IU/1 ; MM fraction was 100 %. She was diagnosed as malignant syndrome. Cerebrospinal fluid was normocellular with protein 38 mg/dl and glucose 122 mg/dl. Cerebrospinal fluid lactate increased markedly to 3.43 mmol/l, CSF pH was 7.264, HCO₃-14.4 mEq/l, indicating CSF metabolic acidosis. She became afebrile after the 10th hospital day, and gradually but completely recovered within a month. She was discharged on August 16, 1988.

　The anti-dopaminergic activity of metoclopramide was considered to be primarily responsible for the development of malignant syndrome in this case. Cerebrospinal fluid lactic acidosis seemed to reflect hyperpyrexia or malignant syndrome induced derangement of the brain metabolism.