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福島医学会 = The Fukushima Society of Medical Science >
福島医学雑誌 = Fukushima Medical Journal >
Vol.72 (2022) >
Vol.72 No.3 (2022) >

Please use this identifier to cite or link to this item: http://ir.fmu.ac.jp/dspace/handle/123456789/1940

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Title: 常用量アセトアミノフェンによる昏睡型急性肝不全の一例
Other Titles: A case of acute hepatic failure with hepatic coma caused by regular doses of acetaminophen
Authors: 鈴木, 健悟
木暮, 敦子
持丸, 友昭
佐藤, 俊
大島, 康嘉
坂, 充
近藤, 祐一郎
Source title: 福島医学雑誌
Volume: 72
Issue: 3
Start page: 121
End page: 125
Issue Date: 2022
Abstract: アセトアミノフェン(acetaminophen:AAP)は,一般に非ステロイド性抗炎症薬(non-steroidal anti-inflammatory drugs:NSAIDs)と比較して副作用が少ない解熱鎮痛薬として,高齢者や肝腎機能障害を有する患者にも頻用されている。一方で肝障害の副作用が知られ,肝疾患のある患者では1,500 mg/日以下とすべきであると記載されている。今回,常用量AAPによる昏睡型肝不全の一例を経験したので報告する。症例は意識障害を主訴に当院へ救急搬送された73歳の女性。左変形性膝関節症に対して,左膝関節全置換術施行後もAAP 1,200 mg/日の内服を2カ月間継続していた。搬送時にJapan Coma Score (JCS) 200の意識障害と黄疸,全身性浮腫を認めた。高度の肝機能障害と凝固障害,肝萎縮があり,昏睡型急性肝不全と診断し加療を開始した。集学的に加療を行ったものの,第7病日に痙攣が出現し呼吸状態悪化に伴い亡くなった。本症例はAAPによる薬物性肝障害(drug-induced liver injury:DILI) であったと判断した。以前より指摘されていた非アルコール性脂肪性肝疾患(nonalcoholic fatty liver disease:NAFLD)と高齢により,DILIのリスクが高かったと考えた。本症例のようにDILIの危険性のある症例では,定期的な肝機能検査の施行や,症状改善に伴う頓服への変更または減量が推奨される。
Acetaminophen (AAP) is an antipyretic and analgesic drug with fewer side effects than NSAIDs, and is frequently prescribed for the elderly and patients with hepatic and renal dysfunction. On the other hand, known side effects of AAP include hepatic damage, for which reason its dose is recommended to be less than 1,500 mg/day in patients with hepatic disease. Herein, we describe a case of acute hepatic failure with hepatic coma attributed to regular doses of AAP. A 73-year-old woman in a coma was brought to our hospital. She had been taking 1,200 mg/day of AAP for 2 months after a total knee arthroplasty for left knee osteoarthritis. At the time of admission, the patient’s Japan Coma Scale (JCS) score was 200; she had jaundice and generalized edema. With severe liver dysfunction, coagulopathy, and hepatic atrophy, she was diagnosed with acute hepatic failure and hepatic coma. Despite aggressive multidisciplinary treatment, the patient died on the seventh day of hospitalization, with convulsions and worsening of respiratory status. We concluded that this was a case of drug-induced liver injury (DILI) caused by AAP. The risk of DILI was considered to be high due to the presence of nonalcoholic fatty liver disease (NAFLD), previously diagnosed, and advanced age. In patients at risk of DILI, as in the present case, periodic liver function tests should guide the cessation or dose reduction of AAP to minimize risks of hepatic dysfunction and possible mortality.
Publisher: 福島医学会
language: jpn
URI: http://ir.fmu.ac.jp/dspace/handle/123456789/1940
Full text URL: http://ir.fmu.ac.jp/dspace/bitstream/123456789/1940/1/FksmMedJ_72_p121.pdf
ISSN: 0016-2582
DOI: 10.5387/fmedj.72.3_121
Related Page: https://doi.org/10.5387/fmedj.72.3_121
Rights: © 2022 福島医学会
Appears in Collections:Vol.72 No.3 (2022)

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