독시라민 중독에서 발견되는 혈뇨와 그 임상적 의의 = The Relation between Rhabdomyolysis and Microscopic Hematuria in Doxylamine Ingested Patients

다국어 초록 (Multilingual Abstract)

Background:Doxylamine is the most commonly intoxicated drug in the emergency room. This drug is relatively safe but is known to induce rhabdomyolysis and acute renal failure in rare occasions. We found the presence of microscopic hematuria in doxylamine intoxicated patients. But no previous studies have documented this hematuria. Our objectives of this study were to determine the incidence of microscopic hematuria after doxylamine overdose and to find the prognostic factors that contribute to this complication.
Methods:This study was conducted from 22 patients admitted to Kyung Hee Medical Center after doxylamine intoxication during the period from January 2001 to December 2003. Using the protocol made beforehand, the amount ingested, past history and laboratory results were recorded. Rhabdomyolysis was defined as serum myoglobin over 300 ng/mL or serum creatine phosphokinase (CK) over 1,000 IU/L. Data were analyzed using SPSS program with t- test, Fisher's exact test and discriminant analysis.
Results:The microscopic hematuria was detected in 63.6% of patients. The amount ingested per body weight, presence of rhabdomyolysis and the time when the muscle enzymes reach highest level were related to the hematuria.
Conclusion:The incidence of microscopic hematuria was higher when more than 30 mg per body weight of doxylamine was ingested than less this amount. Microscopic hematuria suggests the presence of kidney and urinary tract injury. Urine pH of hematuria is over 7.5. Our findings provide no support for the belief that the ferrihemate injures the kidney of doxylamine ingested patients. (Korean J Nephrol 2005;24(4):618-625)

국문 초록 (Abstract)

목 적:독시라민은 수면효과를 지닌 항히스타민제이며 다량 복용하면 횡문근융해증과 급성신부전증까지 초래할 수 있는 것으로 알려져 있다. 독시라민 중독환자들 중에서 실험실검사를 하루 1-2회씩 추적관찰 중에 초기검사에서 정상이었던 소변검사에서 혈뇨가 발견되어, 진단 및 처치에서 혼선을 초래하는 경우가 많았다. 이에 독시라민 중독환자에게서 실제로 혈뇨가 발생하는지와 그 임상적 의의를 알아보고자 하였다.
방 법:2001년부터 2003년까지 독시라민 중독환자를 대상으로 하여 환자들의 의무기록을 후향적으로 조사하여 22명을 선정하였고, 2001년 동안 도뇨관을 삽입하였던 외과중환자실의 다른 환자 96명을 선정하여 혈뇨의 발생여부와 임상적 특징을 비교하였다.
결 과:독시라민 중독환자에게 혈뇨가 발생하였고 대조군과는 유의한 차이가 있었다. 혈뇨는 복용량과의 관계가 있으며, 근육효소수치가 최고점인 시기와 관련이 있었고, 횡문근융해증이 합병된 환자의 대부분에서 발견되었다.
결 론:혈뇨가 발생한 환자에게서 혈뇨가 사라질 때까지 특별한 합병증이 발생하지 않았다면 더 이상의 문제가 없을 수 있다는 예상을 할 수 있고, 또한 퇴원 시기 결정에 도움을 줄 수 있을 것으로 생각된다. 또한 독시라민의 중독에서 발생하는 혈뇨는 횡문근융해증과 유의한 연관이 있었다.

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