A case of chronic alcoholism that developed Wernicke's encephalopathy after hemodialysis initiation

キーワード:Wernicke 脳症,透析,ビタミンB1,代謝性アシドーシス,アルコール 〈要旨〉 2010年に血液透析を導入された 40年来の慢性アルコール中毒の 67歳,男性.2011年 3月より食欲低下があり,4 月に 30 mg/dLの低血糖と pH 7.19のアシデミアを認め,救急搬送された.Anion‒Gap(AG)23.9の AG開大性代 謝性アシドーシスを認め,見当識障害・運動失調も伴い,ビタミン B1欠乏によるWernicke脳症(WE)が考えら れ,ビタミン補充により改善した.入院時ビタミン B1値は 13 ng/mLと低値であった.当院の食欲良好な維持透析 患者 20人のビタミン B1値は,透析前 30.4±6.7,透析後 30.2±7.2 ng/mLと有意差を認めなかった一方で,透析下 のWEは複数報告され,透析によるビタミン B1喪失が指摘されている.食欲低下のみられる透析患者の代謝性アシ ドーシスでは,ビタミン B1欠乏を積極的に考慮すべきである.

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