A 55-year-old man was transferred to our hospital after an attempted suicide by oral ingestion of dipterex. He was diagnosed with organophosphate poisoning, and supportive therapy focusing on respiratory management was provided. Rehabilitation began from day 4 of illness. He complained of difficulty in moving both legs on day 25 and difficulty with walking on day 33. He became to satisfy the diagnostic criteria of ICU-acquired weakness, but based on the rehabilitation history and physical findings, he was diagnosed with organophosphate-induced delayed neuropathy (OPIDN). Rehabilitation to severe patients from early stage may result in correct diagnosis and care.
"},{"@language":"ja","@value":"症例は55歳男性。自殺企図で有機リン製剤を飲み, 埼玉医科大学総合医療センターに救急搬送された。病着時, Glasgow Coma Scale 14 (E3V5M6) と軽度の意識障害と瞳孔径2mm/2mmの縮瞳, および著明な流涎を認めていた。血液検査ではコリンエステラーゼ値が4U/Lと低下し, 血清からはジクロルボスが検出された。有機リン中毒と診断し呼吸管理を中心に加療を行った。第4病日からリハビリテーション (以下, リハビリ) を開始したが, 第25病日に両足の動かしづらさを訴えるようになった。第33病日に歩行困難となりICU-acquired weaknessの診断基準を満たすようになったが, リハビリ病歴から原因は有機リンの遅発性多発神経炎と診断できた。このため病態に沿ったリハビリが継続できた。第43病日に自力歩行が可能となり, 第65病日に独歩で転院した。重症患者に早期からリハビリを導入することは, 治療のみならず診断にも寄与する可能性がある。
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Kanto"},{"@language":"ja","@value":"日本救急医学会関東地方会"}],"prism:publicationDate":"2018-12-31","prism:volume":"39","prism:number":"2","prism:startingPage":"315","prism:endingPage":"318"},"url":[{"@id":"https://search.jamas.or.jp/link/ui/2020109346"}],"availableAt":"2018-12-31","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=ICUAW","dc:title":"ICUAW"},{"@id":"https://cir.nii.ac.jp/all?q=OPIDN","dc:title":"OPIDN"},{"@id":"https://cir.nii.ac.jp/all?q=%E3%83%AA%E3%83%8F%E3%83%93%E3%83%AA%E3%83%86%E3%83%BC%E3%82%B7%E3%83%A7%E3%83%B3","dc:title":"リハビリテーション"},{"@id":"https://cir.nii.ac.jp/all?q=intensive%20care%20unit%20acquired%20weakness","dc:title":"intensive care unit acquired weakness"},{"@id":"https://cir.nii.ac.jp/all?q=organophosphate-induced%20delayed%20neuropathy","dc:title":"organophosphate-induced delayed neuropathy"},{"@id":"https://cir.nii.ac.jp/all?q=rehabilitation","dc:title":"rehabilitation"}],"dataSourceIdentifier":[{"@type":"JALC","@value":"oai:japanlinkcenter.org:2006650460"},{"@type":"CIA","@value":"130007553636"}]}