頭部外傷回復期のmetabolic alkalosis

METABOLIC ALKALOSIS IN CONVALESCENCE OF HEAD INJURY

I．はじめに

　私どもは先に頭部外傷急性期にくる酸塩基平衡障害を報告した^19）。その中で，救命できた症例が，昏睡から回復し半昏睡またはconfusionの状態になる時期にほぼ一致してmetabolic alkalosisがおこることについても言及した。この現象と原因を検討したので報告する。

Five patients were selected who had head injury and had been in coma or semicoma for over 21 hours. Acid-base balance of these patients were studied when they were recovering from unconscious state. All of these cases had no apparent damage in other organs at the time of injury and survived without developing any serious change on vital signs following the admission.

When their consiousness level recovered to the state that they were able to answer on calling their names, results of their blood gas analysis were PH> 7.42, PCO₂=35-45mmHg and BE> +2.3 mEq/L (metabolicalkalosis). In many cases respiratory alka-losis was combined at the same time. Occasionally respiratory acidosis was associated. Acid-base balance of these patients became normal as their consciousness and neurological condition recovered.

As for the cause of this metabolic alkalosis, a con-sideration was made on the possibility of hypokalmia which occur on the convalescence of acute renal tubular necrosis.