{"@context":{"@vocab":"https://cir.nii.ac.jp/schema/1.0/","rdfs":"http://www.w3.org/2000/01/rdf-schema#","dc":"http://purl.org/dc/elements/1.1/","dcterms":"http://purl.org/dc/terms/","foaf":"http://xmlns.com/foaf/0.1/","prism":"http://prismstandard.org/namespaces/basic/2.0/","cinii":"http://ci.nii.ac.jp/ns/1.0/","datacite":"https://schema.datacite.org/meta/kernel-4/","ndl":"http://ndl.go.jp/dcndl/terms/","jpcoar":"https://github.com/JPCOAR/schema/blob/master/2.0/"},"@id":"https://cir.nii.ac.jp/crid/1390282679346825856.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.3893/jjaam.25.821"}},{"identifier":{"@type":"NAID","@value":"130004840988"}},{"identifier":{"@type":"URI","@value":"https://search.jamas.or.jp/link/ui/2015143918"}}],"dc:title":[{"@language":"ja","@value":"遅発性に重篤な中毒症状を来したカルバマゼピン中毒の1例"},{"@language":"en","@value":"Acute carbamazepine poisoning causing late-onset critical toxic symptoms: a case report"}],"dc:language":"ja","description":[{"type":"abstract","notation":[{"@language":"en","@value":"In this report, we describe a case of late-onset respiratory depression and seizure caused by carbamazepine (CBZ) overdose. A 15-year-old female was admitted unconscious with suspicion of drug overdose. The drugs found at the scene were CBZ and mirtazapine. A urine drug screen was positive for tricyclic antidepressant. She suffered respiratory depression, seizure, mydriasis and oliguria after admission, which required mechanical ventilation and intravenous administration of anticonvulsant and lipid emulsion. The concentration of CBZ in her blood was high enough to diagnose intoxication. These symptoms improved in accordance with the decrease of CBZ concentration, and she was discharged without complications on hospital day 8. Approximately 100 tablets of CBZ (200 mg) and 50 of mirtazapine (15 mg) were ascertained to have been ingested 11 hours before arrival. The latency of respiratory depression and seizure after ingestion were 12 hours and 15 hours, respectively. The maximum blood concentration of CBZ was 104.5 µg/mL 20 hours after ingestion, and a concentration below the toxic level was confirmed 67 hours after ingestion. It should be emphasized that because of the considerable latency, a CBZ overdose might cause serious symptoms later. Therefore, close observation is required even if the initial symptoms seem minor."},{"@language":"ja","@value":"カルバマゼピンはてんかん，三叉神経痛に適応があり広く処方されている。今回，我々は遅発性に重篤な症状を来した急性カルバマゼピン中毒の1例を経験したので報告する。<b>症例</b>：患者は15歳の女性。カルバマゼピン 400mg/day，ミルタザピン 15mg/dayを定期内服していた。自宅で倒れているところを発見され，当センターへ救急搬送となった。来院時，意識レベルはGlasgow coma scale E1V1M4で意識障害を認めた。トライエージDOA<sup>®</sup>では三環系抗うつ薬（TCA）陽性であった。カルバマゼピン中毒を疑い経過観察入院とした。集中治療室に入室後，呼吸抑制を来したため人工呼吸器管理を開始した。また入室約3時間後に散瞳と全身性のけいれん発作を呈したためジアゼパム，ミダゾラムの投与を行った。カルバマゼピンの消化管からの吸収は緩徐であるため血中濃度の上昇が持続していると考え，またカルバマゼピンのLogP値が2.5であることから，脂肪製剤の静脈投与を行った。翌朝，カルバマゼピン血中濃度が高値であることが判明し，カルバマゼピン中毒と確定診断した。カルバマゼピンの抗利尿作用による乏尿と消化管運動低下を認めたが，血中濃度の低下とともに改善した。第8病日障害を残さず退院した。本人より，搬送約11時間前にカルバマゼピン200mg錠を約100錠，ミルタザピン錠15mg錠を約50錠内服したと聴取した。内服から呼吸抑制出現まで約12時間，けいれん発作出現まで約15時間と推定された。カルバマゼピンの血中濃度は，最高値が内服から約20時間後（104.5µg/mL），中毒域（20µg/mL）を下回ったのが約67時間後と遷延を認めた。<b>結語</b>：カルバマゼピン中毒患者は服用半日以上経過しても重篤な副作用が出現することがあり，来院時の症状が軽微であっても慎重な経過観察を要すると考えられる。"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1420282801211900160","@type":"Researcher","personIdentifier":[{"@type":"KAKEN_RESEARCHERS","@value":"70597509"},{"@type":"NRID","@value":"1000070597509"},{"@type":"NRID","@value":"9000410626646"},{"@type":"NRID","@value":"9000257733678"},{"@type":"NRID","@value":"9000017479426"},{"@type":"NRID","@value":"9000411499306"},{"@type":"NRID","@value":"9000017289801"},{"@type":"NRID","@value":"9000391760562"},{"@type":"NRID","@value":"9000243904180"},{"@type":"NRID","@value":"9000403303891"},{"@type":"NRID","@value":"9000411563780"},{"@type":"NRID","@value":"9000329438791"},{"@type":"NRID","@value":"9000409494130"},{"@type":"NRID","@value":"9000392158838"},{"@type":"NRID","@value":"9000411498998"},{"@type":"NRID","@value":"9000283333168"},{"@type":"NRID","@value":"9000283333437"},{"@type":"NRID","@value":"9000261665695"},{"@type":"NRID","@value":"9000404094761"},{"@type":"NRID","@value":"9000411499202"},{"@type":"NRID","@value":"9000411499351"},{"@type":"NRID","@value":"9000406034980"},{"@type":"NRID","@value":"9000409633368"},{"@type":"NRID","@value":"9000283333540"},{"@type":"NRID","@value":"9000283333637"},{"@type":"NRID","@value":"9000398404889"},{"@type":"NRID","@value":"9000389553259"},{"@type":"NRID","@value":"9000403155896"},{"@type":"NRID","@value":"9000392383004"},{"@type":"NRID","@value":"9000411238513"},{"@type":"NRID","@value":"9000414080206"},{"@type":"NRID","@value":"9000411499085"},{"@type":"NRID","@value":"9000345220770"},{"@type":"NRID","@value":"9000411499012"},{"@type":"NRID","@value":"9000411805810"},{"@type":"NRID","@value":"9000392343877"},{"@type":"RESEARCHMAP","@value":"https://researchmap.jp/tomoyahirose"}],"foaf:name":[{"@language":"ja","@value":"廣瀬 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Acute Critical Medicine, Osaka University Graduate School of 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