著明な代謝性アシドーシスを呈した脚気衝心の1例 SHOSHIN BERIBERI WITH SEVERE METABOLIC ACIDOSIS

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患者は36歳女性で顔面と下肢の浮腫,倦怠感および意識障害を伴い入院した.血圧低下と著明な代謝性アシドーシス,心拍出量の増加,体血管抵抗の低下,中心静脈圧の上昇を認めた.血液検査ではチアミン値の低下とを認めた.高心拍出量性心不全と代謝性アシドーシスの状態を呈した脚気衝心であった.チアミンの投与後,循環動態は改善し,アシドーシスも急速に正常化した.患者は仕事の多忙差に追われて,インスタント食品および冷凍食品を中心とした食生活を長時間続けていた.<br> 一般に低栄養状態や脱水が持続した状態で,原因が不明の代謝性アシドーシス,意識状態の低下や心不全が認められたときには,脚気衝心を疑い,血清チアミンの測定と早期のチアミン投与が試みられるべき診断および治療法である.

Shoshin beriberi is a state of cardiovascular collapse due to metabolic acidosis caused by vitamin B<sub>1</sub> (thiamine) deficiency.<br> A 36-year-old female was admitted to the hospital because of disturbance of consciousness and edema in the lower extremities and face. She had taken only precooked foods for long periods. Hemodynamic abnormalities with a high cardiac output (5.871/min/m<sup>2</sup>) and high CVP (18 cmH<sub>2</sub>O) were observed in a state of severe metabolic acidosis (pH 6.87, BE-21.4mEq/l). Chest X-ray film demonstrated slightly enlarged cardiac size. CT and ultrasound studies revealed the dilated inferior vena cava and enlarged spleen and liver. In cardiac ultrasound test, pericardial effusion was noticed. The circulatory failure and metabolic acidosis were resistant to the intensive therapy with catecholamines, sodium bicarbonate and various fluid transfusions.<br> After administration of thiamine (200 mg IV every day for 4 days), the abnormalities of hemodynamics and acid base balance returned to normal range. Consciousness state also recovered to normal condition in 5 hours after thiamine therapy.<br> In conclusion shoshin beriberi should be considered in patients with malnutrition or alcoholic who develop cardiac failure or metabolic acidosis of unexplained etiology.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 57(8), 2036-2040, 1996-08-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10008523744
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03869776
  • データ提供元
    CJP書誌  J-STAGE 
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