持続的血液ろ過透析が著効した致死的アルコール性ケトアシドーシスの１救命例

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  • A case of lethal alcoholic ketoacidosis successfully recovered with continuous hemodiafiltration

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A 48-year-old female, who had drunken and taken little food for a week, complained of lumbago, abdominal pain, and amblyopia. Laboratory abnormalities such as hyponatremia, hypochloremia, and elevation of GOT, amylase, and bilirubin levels were present. Blood glucose was within normal range. Arterial blood gas analysis showed severe metabolic acidosis (pH 6.64, BE -37.5 mmol/l) although circulation and oxygenation were maintained at this time. The next day, she caused cardiopulmonary arrest in hospital. After resuscitation, laboratory data showed hyperkalemia (K 8.3 mEq/l), hypoglycemia, and lactic acidosis (pH 6.64, BE-33.5 mmol/l, lactate 229 mg/dl) . Bicarbonate, glucose, and thiamin were administered, but severe hypotension and acidosis did not improve. She was diagnosed as alcoholic ketoacidosis (AKA) because of existence of ketosis with low ratio of serum acetoacetate/ β-hydroxybutyrate. Continuous hemodiaf iltration (CHDF) was operated to her to remove alcohol, ketones, and lactate. After the start of CHDF, acidosis and hypotension were remarkably improved. She successfully recovered though she had complicated acute renal failure and DIC. In conclusion, we must consider AKA in a case of drunken patient with metabolic acidosis. CHDF is useful for severe AKA with persistent shock and acidosis.

収録刊行物

  • 蘇生

    蘇生 22 (2), 125-128, 2003

    日本蘇生学会

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