高カロリー輸液施行中に乳酸アシドーシスを呈した消化器癌患者の4例  [in Japanese] FOUR CASES OF LACTIC ACIDOSIS IN PATIENTS WITH GASTROINTESTINAL CANCER DURING TOTAL PARENTERAL NUTRITION  [in Japanese]

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Abstract

高カロリー輸液(TPN)施行中にビタミンB1欠乏による乳酸アシドーシスを呈した消化器癌患者4例を報告する.第1・2症例では,それぞれ進行胃癌および肺・骨転移を伴う肝細胞癌で全身化学療法に伴う嘔気,嘔吐により経口摂取が不能となった.第3・4症例では膵頭十二指腸切除術後で,食思不振から経口摂取が不能となった.いずれもTPN中にはビタミン剤が添加されておらず,経口摂取不能となってから平均25日後に,突然の意識レベルの低下,血圧の低下,呼吸促迫で発症し,著明な代謝性アシドーシスを呈した.血中乳酸値は平均127.9mg/dlと増加しており,チアミンの投与により臨床症状とアシドーシスは速やかに改善した.こうした悪性腫瘍に対する化学療法中や,術後の消耗状態での補助的TPN施行時には本症を念頭においた患者管理が必要である.

We report herein 4 cases of lactic acidosis found in patients with gastrointestinal cancer, who were being given total parenteral nutrition (TPN). The first patient had advanced gastric cancer, the second patient hepatocellular carcinoma with lung and bone metastasis. Both were treated with chemotherapy, and refused meals because of severe nausea. The third and fourth cases refused meals because of poor appetite after having undergone pancreatoduodenectomy. In each case, the patient received TPN without vitamins. At 25 days on average after they had stopped eating, clouding of consciousness, peripheral circulatory failure, and tachypnea suddenly occurred. Severe metabolic acidosis was disclosed. Serum lactate was 127.9mg/dl on average. Upon giving thiamine intravenously these symptoms dramatically resolved. It was considered that in patients who were being treated with chemotherapy, and who were exhausted after having undergone major surgery, TPN should be performed carefully to avoid lactic acidosis.

Journal

  • The journal of the Japanese Practical Surgeon Society

    The journal of the Japanese Practical Surgeon Society 58(10), 2458-2461, 1997-10-25

    Japan Surgical Association

References:  8

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008531339
  • NII NACSIS-CAT ID (NCID)
    AN00198696
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03869776
  • Data Source
    CJP  CJPref  J-STAGE 
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