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題名 | Clinical and Laboratory Features of Chronic Bromvalerylurea Intoxication=慢性溴滑利尿素中毒之臨床以及實驗室檢查特性 |
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作者 | 吳欣吉; 朱柏齡; 林鴻瑋; 陳金順; 林石化; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷期 | 24:2 2010.06[民99.06] |
頁次 | 頁79-84+125 |
分類號 | 418.82 |
關鍵詞 | 陰離子間隙; 溴化物中毒; 溴滑利尿素; 高血氯; Anion gap; Bromide intoxication; Bromvalerylurea; BVU; Hyperchloremia; |
語文 | 英文(English) |
中文摘要 | 背景:台灣有許多含有溴滑利尿素(bromvalerylurea, BVU)的成藥,如明通治痛丹(BVU 200毫克)、五分珠(BVU 180毫克)、長安治痛丹(BVU 100毫克)、天仙錠(BVU 150毫克)、雙豹治痛錠(BVU 166.7毫克)以及妹事痛(BVU 180毫克)。服用溴滑利尿素(bromvalerylurea, BVU)導致慢性溴化物中毒仍鮮為人知。此研究目的是要評估慢性溴滑利尿素中毒病患臨床、影像學以及實驗室檢查的特性。方法:我們從6年的回朔性研究中找出慢性溴滑利尿素中毒的病患,診斷慢性溴滑利尿素中毒是根據血中溴離子濃度異常且有習慣性使用含有溴離子的溴滑利尿素藥物,並將臨床表現、影像學發現、血中、尿中的實驗室檢查結果以及治療的成效記錄下來。結果:從此研究當中找出八位病患(女性:男性=6:2,平均年紀54歲),血液中浪離子濃度為11.0±4.2毫莫耳/升,這些病患皆因不同原因如頭痛、下背痛、全身關節痠痛或是長期失眠而服用含有溴滑利尿素的市售非處方成藥,這些病患的劑量從每天800至2400毫克,服藥期間自兩個月至二十年皆有。一開始的診斷則包含了兩位是多發性骨髓瘤、各一位是急性瞻望、低血鈉、厭食症以及腦神經病變。神經學表現主要為運動失調、幻覺、言詞含糊、憂鬱表現,在接受神經影像檢查的五位病患當中有二位病患有異常發現,血中氯籬子濃度為133±10毫莫耳/升,而陰離子間隙為-19.2±8.8毫莫耳/升。全部病患皆以靜脈注射生理食鹽水以及/或是環式利尿劑來治療,有兩位病患即便停止藥物並接受治療後仍有神經學上的後遺症。結論:慢性溴滑利尿素中毒之特徵為神經學異常表現加上神經影像學異常結果以及高血氯。醫師快速的辨識出溴滑利尿素中毒並迅速的給予治療可以避免不可逆的後遺症。 |
英文摘要 | Background: Chronic bromide intoxication due to bromvalerylurea (BVU) has not been thoroughly investigated in Taiwan. This study was to evaluate the clinical and laboratory features in patients with chronic BVU intoxication. Methods: We enrolled patients with chronic B VU intoxication from a retrospective 6-year chart review. Chronic BVU intoxication was diagnosed according to abnormal serum bromide concentrations and the habitual use of BVU-containing drugs. Clinical manifestations, laboratory findings in blood and urine, and treatment outcome were recorded. Result: Eight patients (F:M=6:2, mean age 54 years) were identified. Their serum bromide concentrations were 11.0±4.2 mmnol/L. They all habitual/v took BVU-containing over-the-counter (OTC) drugs, (Ming-tong Club Tong Dan. MTCTD) for different purposes such as headache, lumbago, arthralgia, and insomnia. The dosage and duration ranged from 800 to 2400 mug per day and 2 months to 20 years, respectively. Only two patients with bromide intoxication were correctly diagnosed. Other initial diagnosis included multiple myeloma in two, acute delirium in one, acute hvponatremia in one. anorexia nervosa in one, and encephalopathy in one. Ataxia, hallucination, slurred speech, and depressive mood were major neurological symptoms. Three five hod abnormal neuroimaging studies. Although serum chloride (Cl(superscript -)) level was much higher (133±10 mmol/L) with an anion gap-19.2±8.8 mmol/L and positive/v correlated with serum bromide level (p<0.001), it was not regularly measured in six patients on admission. All were successfully treated with intravenous saline and/or loop diuretics. Two had residual neurological symptoms even after withdrawal of the offending drug. Conclusion: Besides spurious hyperchloremia, neurological manifestations associated with abnormal neuroimage are additional clue for chronic BVU intoxication. A rapid recognition of BVU intoxication with prompt management can prevent irreversible neurological sequelae. |
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