経口ジクロフェナクナトリウムが原因と思われる重篤なアレルギー反応の1例

DOI 参考文献13件
  • 卯田 昭夫
    Deppartment of Dentistry, Yomiuri Clinic Department of Anesthesiology, Nihon University School of Dentistry at Matsudo
  • 市倉 治
    Deppartment of Dentistry, Yomiuri Clinic
  • 荒木 佳苗
    Deppartment of Dentistry, Yomiuri Clinic
  • 加來 洋子
    Department of Anesthesiology, Nihon University School of Dentistry at Matsudo
  • 渋谷 鉱
    Department of Anesthesiology, Nihon University School of Dentistry at Matsudo

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タイトル別名
  • A case of severe allergic reaction that was caused by oral administration of diclofenac sodium

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Diclofenac sodium (Voltaren®) had been frequently administered for menstrual pain, and post tooth extraction pain alleviation by patients even though there are risks of allergic reactions. The patient was a 30 year-old woman with body weight of 45kg and a height of 156cm. Neither the patient's past medical nor family history revealed any relevant information. As to the present illness, the patient sought medical attention at our institution for periodontitis of the right mandibular third molar 19 months ago. Cefuroxime axetil (Oracef®) and loxoprofen sodium (Loxonin®) were administered, which did not have any adverse effects to the patient. At the request of the patient, tooth extraction was performed under infiltration anesthesia by administering 2.7ml of 2% dental lidocaine with 1: 80000 epinephrine after induction of topical anesthesia. The tooth extraction was uneventful and took approximately 10 minutes to complete. Fifty minutes after tooth extraction, the patient took 250mg of Oracef® and 50mg of Voltaren®, and 45 minutes later the patient visited our institution again due to chill sensation. The patient experienced nausea, facial pallor, lapses in consciousness, acrotism, severe abdominal pain and watery diarrhea. The patient was immediately placed on fluid therapy, and 500mg of hydrocortisone sodium succinate (Solu-Cortef®) and 20mg of scopolamine butylbromide (Buscopan®) were administered intravenously. The patient recovered in approximately 25 minutes: blood pressure 112/82mmHg, pulse rate 64 beats/minute, SpO2 100% and axillary temperature 37.2°C. Cutaneous symptoms and dyspnea were not confirmed. Lymphocyte stimulation test revealed a positive reaction to Voltaren®.<BR>Needless to say, it is important to ascertain allergic predisposition, allergy history and medication history to avoid allergic reactions and shock. However, since this patient was taking a separate selfadministered analgesic the allergic reaction could not have been avoided.

収録刊行物

  • 有病者歯科医療

    有病者歯科医療 13 (2), 79-83, 2004

    一般社団法人 日本有病者歯科医療学会

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