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カフェイン中毒

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カフェインは入手が容易なOTC製剤含有成分のひとつですが、時として致死的となります。その対応と臨床的特徴について簡単にまとめました。このスライドは文献をもとに作成しておりますが、あくまで一個人の見解であり, 病院全体の方針や意見を反映するものではありません。臨床現場へのそのままの応用は厳に慎んでください。また、スライドをお読みの方が患者・患者関係者の場合は、本内容の利用の際には必ず主治医にご相談ください。なにかご不明な点がございましたら、コメントください。

Published in: Health & Medicine
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カフェイン中毒

  1. 1. カフェイン中毒 疾患各論 聖路加国際病院 救命救急センター 清⽔ 真⼈
  2. 2. 聖路加国際病院 救急部について l 年間11,000台の救急⾞と 45,000⼈の外来患者を ほぼ全て救急部初療(⼩児科や産婦⼈科を除く)にて診療. l 都内では珍しい⼤規模ER型救命センターです. l スタッフ構成 (指導医3名, 専⾨医2名, 後期研修医7名) l ⾒学, 研修はいつでも募集中です! l 連絡先:清⽔真⼈ (  shimasa@luke.ac.jp)
  3. 3. 2015年12⽉21⽇ 報道 九州に住む20代男性が昨年, カフェインを過剰に 摂取し, 中毒死していたことが分かった. 解剖した福岡⼤法医学教室の久保真⼀教授が21⽇, 記者会⾒で明らかにした. カフェインを含む清涼飲料⽔などを短時間に たくさん飲んだとみられ, 久保教授は過剰摂取に 注意を呼びかけている (以下略) l  カフェイン過量服薬患者はしばしば来院 l  対応と臨床的特徴を確認しておこう
  4. 4. カフェイン中毒について l  ⼊⼿が容易なOTC製剤含有成分であるが, 時として致死的となる. l  嘔気・頻拍・低⼒リウム・乳酸アシドーシスを 認める場合, カフェイン中毒の可能性を考える. l  テオフィリンと同様, キサンチン誘導体の1つ. 違いはメチル基1つであることもあり, その中毒症状はテオフィリンと類似している 分⼦量  分布容積  蛋⽩結合率 半減期  212.21 0.6L/kg 36% 2-10h キサンチン誘導体 中毒研究 21:69-73. 2008
  5. 5. 中毒量と致死量 l  経⼝摂取された場合,ほぼ100%が吸収される l  中毒量は1~3g (中毒濃度≧25µg/ml) l  致死量は5~50g (致死濃度≧80~100µg/ml) l  半減期はおよそ5~8時間 チトクロームP450系により代謝される. 7本で中毒量!150mg/本10錠で中毒量!100mg/錠 Modern Physician 34(2): 191 -195 2014
  6. 6. 中毒量と致死量 20杯で中毒量! 50mg/杯
  7. 7. 推定作⽤機序 ①  アデノシン受容体に対する競合拮抗作⽤ –  アデノシンと構造式が類似している –  痙攣の閾値低下, 期外収縮惹起 ②  内因性⼒テコラミン遊離の促進作⽤ –  βアドレナリン受容体刺激作⽤ ③  呼吸中枢への直接刺激作⽤ –  頻呼吸, ⼤呼吸 ④  PDE阻害作⽤による細胞内cAMP増加作⽤ –  ⾎管拡張, ⼼筋刺激作⽤, 中枢神経刺激作⽤ Modern Physician 34(2): 191 -195 2014
  8. 8. 利尿作⽤ Kの細胞内移⾏ 呼吸性アルカローシス 低K⾎症の原因 レニン分泌促進作⽤ ⼼拍出量増加 近位尿細管再吸収阻害 低K⾎症 βアドレナリン 刺激作⽤ アデノシン受容体 拮抗作⽤ 呼吸中枢への 直接刺激作⽤ PDE阻害作⽤ Modern Physician 34(2): 191 -195 2014
  9. 9. カフェイン中毒の症状 l  消化器症状が出やすい l  致死的になるのは, 循環器症状 l  濃度と症状の関連性に ついて症例報告等は あるが, エタノールの ように決まったものは ない Modern Physician 34(2): 191 -195 2014
  10. 10. 循環器症状が致死的となる 多源性の⼼室性期外収縮 Modern Physician 34(2): 191 -195 2014
  11. 11. カフェイン中毒の治療 l  服⽤後1時間以内であれば胃洗浄を考慮 l  活性炭投与は吸収阻害において ⾮常に効果的であるとされている. –  初療において活性炭1g/kg経管投与 –  活性炭0.5~1g/kg 2~4時間ごとに反復投与 –  カフェイン⾎中濃度25 µg/mL未満を⽬安にする l  βブロッカーが有効なことも Modern Physician 34(2): 191 -195 2014
  12. 12. カフェイン中毒の治療 l  排泄促進のため,急性⾎液浄化法の導⼊も考慮 l  循環破綻した場合, PCPSも加療の選択肢. Modern Physician 34(2): 191 -195 2014
  13. 13. カフェイン中毒疑い YES NO βブロッカーの使⽤検討 重篤な頻脈性不整脈, ⾎圧低下 ⾎中濃度⾼値 80µg/ml 痙攣発作, 重篤な頻脈性不整脈 臨床症状が悪化傾向 YES NO ⾎液浄化療法, PCPS 最低24時間の⼊院加療 参考:臨床中毒学

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