日本臨床麻酔学会 vol.38

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1 454 Vol.38 No.4/Jul 症例報告 日臨麻会誌 Vol.38 No.4, , 2018 カフェイン中毒による発作性上室性頻拍に対してデクスメデトミジンが有効と考えられた 1 症例 西本久子 大橋雅彦 土井松幸 *2 齊藤岳児 *3 中島芳樹 [ 要旨 ] 自殺企図で市販のカフェイン含有薬の多量服薬による急性カフェイン中毒の症例を経験した. 症例は,18 歳, 男性. 急性カフェイン中毒の全身管理目的に ICU に入室した. 症状として発作性上室性頻拍 (paroxysmal supraventricular tachycardia:psvt), 不穏, 高血糖, 高乳酸血症, 低カリウム血症, 多尿を呈していた.ICU では人工呼吸管理と活性炭投与などの対症療法を行った. 不整脈は薬物療法によって制御でき血液透析は施行しなかった. 不穏が強くデクスメデトミジンを主体とした鎮静下で人工呼吸管理を行ったが, 第 4 病日に人工呼吸器を離脱した. 第 5 病日に ICU を退室した. キーワード : カフェイン中毒, 発作性上室性頻拍, デクスメデトミジン はじめに Ⅰ 症例 cm 52kg g 2 Glasgow coma scale E4V2M5 115/70mmHg 186/min PSVT 28/min K 2.8mEq/L 273mg/dL 8.8mmol/L ph 7.36 PaCO mmHg PaO 2 136mmHg HCO mEg/L BE 7.3mEq/ L 75.4mg/L ICU ICU 1 ICU 103/66mmHg 138/min PSVT 2 dexme

2 455 心拍数 乳酸 心拍数 (/min) 乳酸 (mmol/l) 図 1 入室後 12 時間の心拍数, 乳酸値の推移 detomidine DEX, g/h mg/h 200 g/h PSVT ICU 5 g/kg/min PSVT 3 100/min 2 g/kg/min ICU 10 PSVT ICU mmol/L PSVT ICU 図 1, 図 2 Ⅱ 考察 camp mg/L PSVT 4 PSVT 4, 5 DEX

3 456 Vol.38 No.4/Jul 心拍数 乳酸 心拍数 (/min) 乳酸 (mmol/l) 図 2 ICU 入室期間中の経過 ICU DEX 2 DEX Chrysostomou 8 DEX DEX Chrysostomou 10 DEX DEX Lirola 11 DEX 2.5 g/kg/h DEX 結語 DEX

4 参考文献 1) 大谷典生 : カフェイン含有薬剤の過量服薬への対応, Modern Physician 34-2 知っておきたい急性中毒の知識. 上條吉人編. 新興医学出版社, 東京,2014, ) 大山雄樹, 森本文雄 : 病院前に心室細動となったカフェイン中毒の1 例. 日本臨床救急医学会雑誌 14:66-68, ) McGee MB:Caffeine poisoning in a 19-year-old female. J Forensic Sci 25:29-32, ) 佐藤孝幸, 中川隆雄, 仁科雅良ほか : 致死的大量服薬から救命し得た急性カフェイン中毒の 2 例. 日本救急医学 会雑誌 20: ,2009 5) 西村洋一, 岩村高志, 小網博之ほか : 急性期に血液透析を施行し救命しえたカフェイン中毒の 1 例. 日本救急医学会雑誌 24: ,2013 6) Abbott PJ:Caffeine:a toxicological overview. Med J Aust 145: , ) Leson CL, McGuigan MA, Bryson SM:Caffeine overdose in an adolescent male. J Toxicol Clin Toxicol 26: , ) Chrysostomou C, Sanchez-de-Toledo J, Wearden P, et al.:perioperative use of dexmedetomidine is associated with decreased incidence of ventricular and supraventricular tachyarrhythmias after congenital cardiac surgery. Ann Thorac Surg 92: , ) Kamibayashi T, Hayashi Y, Mammoto T, et al.:role of the vagus nerve in the antidysrhythmic effect of dexmedetomidine on halothane/epinephrine dysrhythmias in dogs. Anesthesiology 83: , )Chrysostomou C, Morell VO, Wearden P, et al.:dexmedetomidine:therapeutic use for the termination of reentrant supraventricular tachycardia. Congenit Heart Dis 8:48-56, )Lirola T, Aantaa R, Laitio R, et al.:pharmacokinetics of prolonged infusion of high-dose dexmedetomidine in critically ill patients. Crit Care 15:R257, 2011

5 458 Vol.38 No.4/Jul A Case of Paroxysmal Supraventricular Tachycardia Caused by Caffeine Overdose Successfully Treated with Dexmedetomidine Hisako NISHIMOTO, Masahiko OHASHI, Takeji SAITO *2, Matsuyuki DOI, Yoshiki NAKAJIMA *3 Intensive Care Unit, Hamamatsu University Hospital *2 Emergency Unit, Hamamatsu University Hospital *3 Department of Anesthesiology and Intensive Care, Hamamatsu University Hospital In this report, we describe the case of a patient with caffeine overdose that was successfully treated with critical care. An 18-year-old male intentionally ingested an overdose of caffeine(3.6 g). On admission to the intensive care unit, paroxysmal supraventricular tachycardia(psvt), agitation, hyperglycemia, lactic acidosis, hypokalemia, and polyuria were observed. We performed mechanical ventilation and administered activated charcoal. We were able to manage PSVT with drug therapy, so we did not perform hemodialysis. The patient was extubated on the fourth day of admission and was discharged the following day from the intensive care unit. Key Words : Caffeine overdose, Paroxysmal supraventricular tachycardia, Dexmedetomidine The Journal of Japan Society for Clinical Anesthesia Vol.38 No.4, 2018

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