キチン-キトサンの大量摂取により著明な出血傾向をきたしたと考えられた血液透析患者の1例 Acute bleeding tendency caused by chitin-chitosan preparation in a hemodialysis patient
症例は52歳男性, アルコール性肝硬変の既往あり. 2003年9月に末期腎不全で血液透析療法を開始. 2004年6月30日, 内シャントが閉塞し当院血管外科受診. 術前の出血傾向検査では異常値を認めていない. 入院後, 透析用カテーテルを右内頸静脈に挿入, 穿刺30分後より挿入部から出血し, 呼吸困難となり気管内挿管後, ICUに入室. 入室時の検査では, 血小板数に変化は認めず, APTT, PTの著明な延長, Thrombo Test (TTO), Hepaplastin Test (HPT) の著明な低下を認めた. 急性Vit K欠乏症と診断しVit K製剤の投与を開始した. 投与開始後, カテーテル刺入部からの出血は止血し, 凝固時間も速やかに改善した. 入院直前に市販薬であるキチンーキトサン製剤 (1日30錠: 推薦容量1日10錠) を内服したことが判明した.<br>以上より, 本例の出血傾向の原因としてキチンーキトサン製剤によるVit K欠乏症が考えられた.
A 52-year-old male had been diagnosed with alcoholic liver cirrhosis. He began haemodialysis due to chronic renal failure on 2003. Because of occulusion of the arteriovenous access, he consulted a doctor on June 30, 2004, then he was admitted to our hospital on July 7, 2004, for surgical fistula revision. There was no bleeding tendency observed on preoperative examination. After hospitalization, the catheter for dialysis was inserted into the right internal jugular vein. Thereafter, there was persistent bleeding from the catheter insertion site, and enlargement of the right cervical vein was observed. Because dyspnea became advanced, we began respirator management with endotracheal intubation. At the time of onset, the platelet count was unchanged, but the elongation of the APTT and PT, and the reduction of TTO and HPT were observed. There was no acceleration of the fibrinolysis system, Since Vit K deficiency was suspected, Vit K was administered intravenously. Thereafter, bleeding improved during catheter implantation and serologic data also improved promptly. By a careful examination of his history, it was found that he had been taking chitin-chitosan preparation (one day 30 tablets, with a recommended daily dose of 10 tablets) after preoperative examination. It is considered that the chitin-chitosan preparation affected the absorption of fat-soluble vitamins. Moreover, he had liver cirrhosis, which might result in poor excretion of bile. Since the chitin-chitosan preparation was ingested while bile excretion was declining, it caused a further decrease in bile excretion, then Vit K absorption became poor, leading to acute Vit K deficiency. Since this is the first report of a bleeding tendency caused by chitin-chitosan preparation, we emphasize the need for particular attention to non prescribed health food administration.
- 日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy
日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 39(6), 1197-1201, 2006-06-28
The Japanese Society for Dialysis Therapy