長期少量ジスチグミン臭化物内服中にコリン作動性クリーゼにより高度徐脈に陥った一症例

• Published in: CIRCULATION CONTROL Vol. 34; no. 1-3; pp. 78 - 81
• Main Authors: 重見, 研司, 安田, 善一, 高倉, 康, 松木, 泰成, 村上, 剛, 松木, 悠佳
• Format: Journal Article
• Language: Japanese
• Published: 日本循環制御医学会 2014; Japan Society of Circulation Control in Medicine
• Subjects: cardiopulmonary arrest; cholinergic crisis; dehydration; diarrhea; distigmine bromide
• ISSN: 0389-1844
• DOI: 10.11312/ccm.34.78

Distigmine bromide, a cholinesterase inhibitor widely used for the treatment of underactive neurogenic bladder, can occasionally precipitate cholinergic crisis. We report a 67-year-old woman with neurogenic bladder who had been taking 5mg distigmine bromide orally daily for two years, but developed severe bradycardia when she became dehydrated as a result of diarrhea. She was admitted to the emergency department of our hospital with severe diarrhoea and respiratory failure, and subsequently suffered severe bradycardia. She was soon resuscitated with intravenous injections of atropine and adrenalin, accompanied by insertion of a temporary pacemaker. She was diagnosed with cholinergic crisis induced by distigmine bromide, with myosis and excess salivation. This case suggests that even a small dose of distigmine bromide can induce cholinergic crisis during dehydration caused by severe diarrhoea.