ミチバ
More プロフィール

Search

Calendar

<<　2012/02　>>
日 月 火 水 木 金 土
1 2 3 4
5 6 7 8 9 10 11
12 13 14 15 16 17 18
19 20 21 22 23 24 25
26 27 28 29

トップページ

Doctors Blog

ブログの購読

新着コメント

新着トラックバック

< 事故による有害ガスの吸入/酢酸 | メイン | ビールとコバルト症候群 >
2008.07.29 23:00 |  診療  |  ミチバ  | 推薦数 : 2

シアン中毒

・先日，特異的な有害ガス吸入に対する治療として，シアン中毒に対する，亜硝酸アミル，亜硝酸ナトリウムについて書いたと思います．シアン中毒の治療については，『今日の治療指針 2008年版』の121ページに載っています．その記載でちょっと疑問に思ったのは，亜硝酸アミル液が「保外」と保険適用外のマークがついていますが，「添付文書」をみると，保険適応と思うのですが，いかがなものでしょう？

亜硝酸アミルの添付文書

http://database.japic.or.jp/pdf/newPINS/00008758.pdf

 

・それは，さておきシアン中毒について．今日の治療指針によると「シアン（青酸）化物イオンは，ミトコンドリア中のチトクローム酸化酵素複合体中の鉄と急速に結合し，この酵素を阻害し，細胞内での酸素利用を阻害する．その結果，生体は嫌気的代謝経路を利用するため，乳酸アシドーシスとなる．」とあります．で，治療の原理については，『中毒百科改訂第２版』を引用すると次のようになります．「シアン中毒の特異的治療法は，シアンがFe3+に親和性が強いという性質を逆用して行う．すなわち，正常のメトヘモグロビンをつくる．こうすると，シトクロム酸化酵素のFe3+と結合していたシアンは剥がれてメトヘモグロビンのFe3+と結合し，シアノメトヘモグロビンをつくる．こうして，とりあえず急場をしのいだあと，チオ硫酸ナトリウムを静注すると，硫黄が，シアノメトヘモグロビンから少しづつ遊離してくるシアンと結合し，チオシアネートとなる，これは毒性が低く，腎臓から排泄される．・・・メトヘモグロビン血症をつくるには，亜硝酸ナトリウム300mgを10mLに溶かしたものを血圧低下に注意しながら５分以上かけて静注する．わが国では，市販されていないから試薬を使ってつくる以外にない．これが間に合わない場合には，亜硝酸アミル吸入液（三共）のアンプルを砕いて布にしみ込ませて，鼻や口の近くで吸入させる．」

・今日の治療指針は，上の文章を読まないと理解しにくいのではないでしょうか．亜硝酸アミルは狭心症の治療薬として，結構一般の医療機関においている（んですよね？）ので，それを使用してとりあえず治療する．それで時間稼ぎをして，院内で亜硝酸ナトリウムをつくって静注して治療するということです．

・今日の治療薬には載っていませんでしたが，中毒百科に以下のような注意書きがあります．

「亜硝酸ナトリウムの投与量は，貧血がある場合には少なめにしないと，少ないヘモグロビンのほとんどが酸素運搬能力のないメトヘモグロビンになってしまい，それだけで致命的となる．・・・表の投与量を越えないようにする．・・・」

 

 

表

ヘモグロビン濃度(g/dL） 投与量(mg/kg)   

8                                     6.6

10                                   8.7

12                                   10.0

14                                   11.6

 

参考

http://www.j-poison-ic.or.jp/kagaku/gedokuzai/Onitri_s.pdf#search='亜硝酸ナトリウム'

固定リンク | コメント (1) | トラックバック (120)

トラックバック

この記事のトラックバック URL

http://blog.m3.com/OEM/20080729/2/trackback

トラックバック一覧

Awesome website
[...]the time to read or visit the content or sites we have linked to below the[...]… [続きを読む]
posted from brooksglycerin8 2011.11.11 03:41
2011
I’ve recently started a web site, the info you offer on this site has helped me greatly. Thanks for ... [続きを読む]
posted from YabasYabas 2011.11.17 17:36
2011
I like what you guys are up also. Such smart work and reporting! Carry on the superb works guys I’ve... [続きを読む]
posted from Statesville Ice Cream 2011.11.19 00:09
2011
It’s really a cool and helpful piece of info. I’m glad that you shared this helpful information with... [続きを読む]
posted from Statesville Ice Cream 2011.11.19 06:45
2011
The blog was how do i say it… relevant, finally something that helped me. Thanks [続きを読む]
posted from Twilight Breaking Dawn FULL MOVIE 2011.11.21 01:24
2011
I don’t even know how I ended up here, but I thought this post was good. I don't know who you are bu... [続きを読む]
posted from Twilight Breaking Dawn Part 2 2011.11.21 04:37
Related……
[... ]just beneath, are numerous totally possibly not related sites to our bait, however, they are a... [続きを読む]
posted from jwoww tanning lotion 2011.11.21 08:00
Related……
[... ]just beneath, are numerous totally possibly not related sites to our bait, however, they are a... [続きを読む]
posted from chicken recipes for dinner 2011.11.22 01:50
2011
I’d have to examine with you here. Which is not one thing I usually do! I take pleasure in reading a... [続きを読む]
posted from Twilight Breaking Dawn Part 2 2011.11.22 11:59
Read was interesting, stay in touch…
[...]please visit the sites we follow, including this one, as it represents our picks from the web[.... [続きを読む]
posted from buy music 2011.11.22 18:54
2011
I’m not sure where you're getting your info, but good topic. I needs to spend some time learning mor... [続きを読む]
posted from Twilight Breaking Dawn FULL MOVIE 2011.11.22 23:22
Sites we Like…
[...] Every once in a while we choose blogs that we read. Listed below are the latest sites that we ... [続きを読む]
posted from Amazon Fires 2011.11.23 07:31
Cool sites
[...]we came across a cool site that you might enjoy. Take a look if you want[...]… [続きを読む]
posted from nioxin vitamins 2011.11.23 18:19
2011
Excellent read, I just passed this onto a friend who was doing a little research on that. And he jus... [続きを読む]
posted from acompañantes 2011.11.24 14:02
Recommeneded websites
[...]Here are some of the sites we recommend for our visitors[...]… [続きを読む]
posted from dumbbells for sale cheap 2011.11.25 23:55
Related…
[...]just beneath, are numerous totally not related sites to ours, however, they are surely worth go... [続きを読む]
posted from bread maker zojirushi 2011.11.27 06:16
Visitor recommendations
[...]one of our visitors recently recommended the following website[...]… [続きを読む]
posted from recaro young sport 2011.11.27 09:46
Our Trackback
[...]Hey there! I know this is kinda off topic but I’d figured I’d ask. Would you be interested in t... [続きを読む]
posted from When Learning Acoustic Guitar 2011.11.27 10:02
Great website
[...]we like to honor many other internet sites on the web, even if they aren’t linked to us, by lin... [続きを読む]
posted from swing sets 2011.11.27 21:39
Cool sites
[...]we came across a cool site that you might enjoy. Take a look if you want[...]… [続きを読む]
posted from Rhinestone Flip Flops 2011.11.28 06:55
Awesome website
[...]the time to read or visit the content or sites we have linked to below the[...]… [続きを読む]
posted from gravity table 2011.11.28 17:47
Superb website
[...]always a big fan of linking to bloggers that I love but don’t get a lot of link love from[...]…... [続きを読む]
posted from breville toaster oven problems 2011.11.28 22:29
Great website
[...]we like to honor many other internet sites on the web, even if they aren’t linked to us, by lin... [続きを読む]
posted from new york headshots 2011.11.29 06:54
Awesome website
[...]the time to read or visit the content or sites we have linked to below the[...]… [続きを読む]
posted from horizon treadmill review 2011.11.29 09:07
Blogs ou should be reading
[...]Here is a Great Blog You Might Find Interesting that we Encourage You[...]… [続きを読む]
posted from pc-tricks 2011.11.29 21:48
Sites we Like…
[...] Every once in a while we choose blogs that we read. Listed below are the latest sites that we ... [続きを読む]
posted from dyson cordless vacuum cleaner 2011.11.30 01:12
{Hi|Hello}, {i think|i feel|i believe} that i {saw|noticed} you visited my {blog|weblog|website|web site|site} {so|thus} i {got here|came} to “{go back|return} the {prefer|choose|favor|want|desire}”.{I am|I'm} {trying to|attempting to} {in finding|find|to find} {things|issues} to {improve|enhance} my {website|site|web site}!{I guess|I assume|I suppose} its {good enough|ok|adequate} {to use|to make use of} {some of|a few of} your {ideas|concepts|ideas}!!
Asian Tiger Mosquito [続きを読む]
posted from Asian Tiger Mosquito 2011.11.30 03:13
Asian Tiger Mosquito
Good – I should definitely pronounce, impressed with your website. I had no trouble navigating throu... [続きを読む]
posted from Asian Tiger Mosquito 2011.11.30 05:10
Related…
[...]just beneath, are numerous totally not related sites to ours, however, they are surely worth go... [続きを読む]
posted from canister vacuums 2011.11.30 07:30
Great website
[...]we like to honor many other internet sites on the web, even if they aren’t linked to us, by lin... [続きを読む]
posted from Reputation Management Experts 2011.11.30 08:58
Websites you should visit
[...]below you’ll find the link to some sites that we think you should visit[...]… [続きを読む]
posted from cheap video games 2011.11.30 09:10
Asian Tiger Mosquito
F*ckin’ remarkable things here. I am very satisfied to look your post. Thank you so much and i'm tak... [続きを読む]
posted from Asian Tiger Mosquito 2011.11.30 11:52
Asian Tiger Mosquito
Hello, you used to write fantastic, but the last several posts have been kinda boring… I miss your t... [続きを読む]
posted from Asian Tiger Mosquito 2011.11.30 14:03
Awesome website
[...]the time to read or visit the content or sites we have linked to below the[...]… [続きを読む]
posted from garmin heart rate monitor 2011.11.30 18:29
Asian Tiger Mosquito
I’ve been exploring for a bit for any high-quality articles or weblog posts on this kind of area . E... [続きを読む]
posted from Asian Tiger Mosquito 2011.11.30 22:19
Sites we Like…
[...] Every once in a while we choose blogs that we read. Listed below are the latest sites that we ... [続きを読む]
posted from binaural beats download 2011.11.30 23:32
Websites worth visiting
[...]here are some links to sites that we link to because we think they are worth visiting[...]… [続きを読む]
posted from S8100 2011.12.01 07:12
Websites you should visit
[...]below you’ll find the link to some sites that we think you should visit[...]… [続きを読む]
posted from Droid Incredible 2 2011.12.01 09:09
Online Article…
[...]The information mentioned in the article are some of the best available [...]... [続きを読む]
posted from Motorola Droid Bionic 2011.12.01 18:36
Accounting Basics
What’s Going down i am new to this, I stumbled upon this I have found It absolutely useful and it ha... [続きを読む]
posted from Asian Tiger Mosquito 2011.12.02 11:43
2011
Hello! I could have sworn I’ve been to this blog before but after browsing through some of the post ... [続きを読む]
posted from Accounting Basics 2011.12.03 23:48
Online Article…
[...]The information mentioned in the article are some of the best available [...]... [続きを読む]
posted from costa rica surf camp 2011.12.06 23:52
2011
Great – I should certainly pronounce, impressed with your website. I had no trouble navigating throu... [続きを読む]
posted from Accounting Basics 2011.12.08 15:36
Wow
[...]below you’ll uncover the link to some sites that we consider you need to visit[...] [続きを読む]
posted from septic tank installation 2011.12.10 17:45
2011
I’ll right away grab your rss feed as I can't find your email subscription link or newsletter servic... [続きを読む]
posted from Asian Tiger Mosquito 2011.12.10 23:30
Sources…
[...]check below, are some totally unrelated websites to ours, however, they are most trustworthy so... [続きを読む]
posted from Cucumber Salad Recipe 2011.12.11 03:22
The best website……
[...]here are some links to sites that we link to because we think they are worth visiting[...]…… [続きを読む]
posted from Chicken Recipes For Dinner 2011.12.12 01:55
Cool sites
[...]we came across a cool site that you might enjoy. Take a look if you want[...]… [続きを読む]
posted from web development India 2011.12.13 00:35
Visitor recommendations
[...]one of our visitors recently recommended the following website[...]… [続きを読む]
posted from check grammar 2011.12.13 02:31
Superb website
[...]always a big fan of linking to bloggers that I love but don’t get a lot of link love from[...]…... [続きを読む]
posted from burlington coat factory coupons 2011.12.13 07:11
Superb website
[...]always a big fan of linking to bloggers that I love but don’t get a lot of link love from[...]…... [続きを読む]
posted from internet Marketing 2011.12.13 21:17
Recommeneded websites
[...]Here are some of the sites we recommend for our visitors[...]… [続きを読む]
posted from Bedroom Furniture Stores 2011.12.14 05:21
The best website……
[...]here are some links to sites that we link to because we think they are worth visiting[...]…… [続きを読む]
posted from Foal Color Calculator 2011.12.14 08:08
2011
Great – I should certainly pronounce, impressed with your website. I had no trouble navigating throu... [続きを読む]
posted from Windows Colorado Springs 2011.12.14 12:14
2011
Hello! I could have sworn I’ve been to this blog before but after browsing through some of the post ... [続きを読む]
posted from Asian Tiger Mosquito 2011.12.14 15:30
Online Article…
[...]The information mentioned in the article are some of the best available [...]... [続きを読む]
posted from white boots 2011.12.14 19:04
Check this out
[...] that is the end of this article. Here you’ll find some sites that we think you’ll appreciate, ... [続きを読む]
posted from tag heuer 2011.12.15 06:42
Cool sites
[...]we came across a cool site that you might enjoy. Take a look if you want[...]… [続きを読む]
posted from ray ban 2011.12.15 07:16
Online Article…
[...]The information mentioned in the article are some of the best available [...]... [続きを読む]
posted from cash for phones 2011.12.15 19:59
[...]always a {big|large|huge|massive|major|significant} fan of linking to bloggers that I {love|adore|really like|enjoy|appreciate|like} but {don’t|do not|really don't} get {a lot|a great deal|a whole lot|a good deal|quite a bit|lots} of link {love|adore|really like|enjoy|appreciate|like} from[...]
[...]just beneath, are a lot of absolutely not associated web-sites to ours, nonetheless, they are s... [続きを読む]
posted from Computer Service Denver 2011.12.16 02:21
Superb website…
[...]always a big fan of linking to bloggers that I love but don’t get a lot of link love from[...]…... [続きを読む]
posted from grease monkey coupons 2011.12.17 01:59
Related…
[...]just beneath, are numerous totally not related sites to ours, however, they are surely worth go... [続きを読む]
posted from barbell shoulder press 2011.12.18 23:54
Recommeneded websites
[...]Here are some of the sites we recommend for our visitors[...]… [続きを読む]
posted from Selbstcoaching 2011.12.19 03:28
Awesome website
[...]the time to read or visit the content or sites we have linked to below the[...]… [続きを読む]
posted from Free Voip Call Worldwide 2011.12.19 06:49
Related…
[...]just beneath, are numerous totally not related sites to ours, however, they are surely worth go... [続きを読む]
posted from merchant leads 2011.12.19 09:18
Recommeneded websites…
[...]Here are some of the sites we recommend for our visitors[...]…… [続きを読む]
posted from Baked Chicken Breast Recipes 2011.12.20 03:06
replacement windows
[...]below you’ll find the link to some sites that we consider it is best to visit[...] [続きを読む]
posted from window replacement colorado springs 2011.12.20 03:58
Sources…
[...]check below, are some totally unrelated websites to ours, however, they are most trustworthy so... [続きを読む]
posted from Vagus Nerve Disorders 2011.12.21 03:54
Thank
[...]below you’ll find the link to some sites that we feel it is best to visit[...] [続きを読む]
posted from calcium carbide and water 2011.12.21 21:35
The best website……
[...]here are some links to sites that we link to because we think they are worth visiting[...]…… [続きを読む]
posted from Mad Hungry Recipes 2011.12.22 04:13
Great website…
[...]here are some hyper-links to sites that we link to as we feel they are really worth browsing[..... [続きを読む]
posted from Toledo Blade Obituaries 2011.12.23 03:07
2011
Hey, you used to write excellent, but the last several posts have been kinda boring… I miss your gre... [続きを読む]
posted from Asian Tiger Mosquito 2011.12.24 23:04
Trackback for a Great Article…
[... ]Left you a trackback for your readers to get more info[... ]…… [続きを読む]
posted from French S Onion Chicken 2011.12.25 02:20
2011
What’s Happening i'm new to this, I stumbled upon this I've found It positively helpful and it has h... [続きを読む]
posted from Asian Tiger Mosquito 2011.12.26 12:02
Recommeneded websites…
[...]Here are some of the sites we recommend for our visitors[...]…… [続きを読む]
posted from online banjo tuner 2011.12.28 03:33
Related……
[... ]just beneath, are numerous totally possibly not related sites to our bait, however, they are a... [続きを読む]
posted from knotts berry farm hours 2011.12.29 06:39
Great website…
[...]here are some hyper-links to sites that we link to as we feel they are really worth browsing[..... [続きを読む]
posted from red dead redemption undead nightmare unicorn 2012.01.02 07:06
The best website
[...]Cleaning and janitorial services also could be searched for around the web[...] [続きを読む]
posted from vikt träning blogg 2012.01.03 05:45
Recommeneded websites…
[...]Here are some of the sites we recommend for our visitors[...]…… [続きを読む]
posted from mathway algebra solver 2012.01.03 10:25
Related……
[... ]just beneath, are numerous totally possibly not related sites to our bait, however, they are a... [続きを読む]
posted from cranial nerve mnemonic 2012.01.04 05:03
Trackback for a Great Article…
[... ]Left you a trackback for your readers to get more info[... ]…… [続きを読む]
posted from Grease Monkey Coupons 2012.01.06 07:32
Great
[...]usually posts some incredibly interesting stuff like this. If you’re new to this site[...] [続きを読む]
posted from Buy Cameras Mobile Phones Clothing Computers Plus More 2012.01.07 12:01
Great
[...]we prefer to honor many other world wide web websites on the web, even though they aren’t linke... [続きを読む]
posted from They keep you on your feet for hours without pain 2012.01.08 17:18
2011
Hi, Neat post. There's a problem with your website in internet explorer, would check this… IE still ... [続きを読む]
posted from seattle organic seo 2012.01.14 13:29
Related…
[...]just beneath, are numerous totally not related sites to ours, however, they are surely worth go... [続きを読む]
posted from bowflex free weights 2012.01.19 17:57
Cool sites
[...]we came across a cool site that you might enjoy. Take a look if you want[...]… [続きを読む]
posted from adjustable dumbbell sets 2012.01.19 20:06
Recent Blogroll Additions…
[...]usually posts some very interesting stuff like this. If you’re new to this site[...]… [続きを読む]
posted from bread maker zojirushi 2012.01.19 21:47
Check this out
[...] that is the end of this article. Here you’ll find some sites that we think you’ll appreciate, ... [続きを読む]
posted from using a tablet 2012.01.20 03:04
Great
[...]usually posts some really interesting stuff like this. If you’re new to this site[...] [続きを読む]
posted from stock market news 2012.01.20 11:02
Blogs ou should be reading
[...]Here is a Great Blog You Might Find Interesting that we Encourage You[...]… [続きを読む]
posted from Notas de prensa 2012.01.20 21:49
Check this out
[...] that is the end of this article. Here you’ll find some sites that we think you’ll appreciate, ... [続きを読む]
posted from DLP Projectors 2012.01.22 00:01
Links
[...]Sites of interest we have a link to[...]… [続きを読む]
posted from Konto eroeffnen trotz Schufa 2012.01.22 20:20
Online Article…
[...]The information mentioned in the article are some of the best available [...]... [続きを読む]
posted from Leaflet Flyer Printing 2012.01.23 21:04
Visitor recommendations
[...]one of our visitors recently recommended the following website[...]… [続きを読む]
posted from Naples NY Real Estate 2012.01.24 03:10
Websites worth visiting
[...]here are some links to sites that we link to because we think they are worth visiting[...]… [続きを読む]
posted from Dominical 2012.01.24 16:11
Cool sites
[...]we came across a cool site that you might enjoy. Take a look if you want[...]… [続きを読む]
posted from forex bonus account 2012.01.24 17:52
Websites you should visit
[...]below you’ll find the link to some sites that we think you should visit[...]… [続きを読む]
posted from Costa Rica news 2012.01.24 21:47
Links
[...]Sites of interest we have a link to[...]… [続きを読む]
posted from Costa Rica Houses For Sale 2012.01.26 02:47
Visitor recommendations
[...]one of our visitors recently recommended the following website[...]… [続きを読む]
posted from Costa Rica SEO 2012.01.26 05:26
Read was interesting, stay in touch…
[...]please visit the sites we follow, including this one, as it represents our picks from the web[.... [続きを読む]
posted from Original abstract painings 2012.01.27 04:53
Blogs ou should be reading
[...]Here is a Great Blog You Might Find Interesting that we Encourage You[...]… [続きを読む]
posted from Luxury Homes 2012.01.27 15:45
The read was interesting, stay in touch…
[...]please visit the sites we follow, including this one, as it represents our picks from the web[.... [続きを読む]
posted from Costa Rica property 2012.01.27 16:38
Websites you should visit
[...]below you’ll find the link to some sites that we think you should visit[...]… [続きを読む]
posted from best treadmills for home 2012.01.27 19:49
Blogs ou should be reading
[...]Here is a Great Blog You Might Find Interesting that we Encourage You[...]… [続きを読む]
posted from brainwave music 2012.01.27 20:01
Visitor recommendations
[...]one of our visitors recently recommended the following website[...]… [続きを読む]
posted from best brainwave entrainment 2012.01.27 21:08
Superb website
[...]always a big fan of linking to bloggers that I love but don’t get a lot of link love from[...]…... [続きを読む]
posted from Recaro Young Sport Child Car Seat 2012.01.29 02:34
Great website
[...]we like to honor many other internet sites on the web, even if they aren’t linked to us, by lin... [続きを読む]
posted from DC25 2012.01.29 03:27
Awesome website
[...]the time to read or visit the content or sites we have linked to below the[...]… [続きを読む]
posted from Mongoose bikes 2012.01.29 21:36
Awesome website
[...]the time to read or visit the content or sites we have linked to below the[...]… [続きを読む]
posted from affiliate networks 2012.01.30 17:02
Online Article…
[...]The information mentioned in the article are some of the best available [...]... [続きを読む]
posted from resume objective 2012.01.30 20:27
Visitor recommendations
[...]one of our visitors recently recommended the following website[...]… [続きを読む]
posted from resume help 2012.01.31 20:32
Recent Blogroll Additions…
[...]usually posts some very interesting stuff like this. If you’re new to this site[...]… [続きを読む]
posted from book templates 2012.01.31 22:20
Blogs ou should be reading
[...]Here is a Great Blog You Might Find Interesting that we Encourage You[...]… [続きを読む]
posted from resume tips 2012.02.01 14:12
Links
[...]Sites of interest we have a link to[...]… [続きを読む]
posted from call for submissions 2012.02.01 16:20
Blogs ou should be reading
[...]Here is a Great Blog You Might Find Interesting that we Encourage You[...]… [続きを読む]
posted from forex bonus 100 2012.02.01 20:52
Online Article…
[...]The information mentioned in the article are some of the best available [...]... [続きを読む]
posted from outdoor wood burning furnace 2012.02.02 18:51
Sites we Like…
[...] Every once in a while we choose blogs that we read. Listed below are the latest sites that we ... [続きを読む]
posted from retire in costa rica 2012.02.03 11:28
Awesome website
[...]the time to read or visit the content or sites we have linked to below the[...]… [続きを読む]
posted from Free $1,000 Walmart Gift Card 2012.02.08 00:26
Related…
[...]just beneath, are numerous totally not related sites to ours, however, they are surely worth go... [続きを読む]
posted from Cheap scrapebox list 2012.02.10 22:25
Related…
[...]just beneath, are numerous totally not related sites to ours, however, they are surely worth go... [続きを読む]
posted from simon marketing 2012.02.12 15:54

コメント

コメント一覧

すみません。亜硝酸アミル、って一般的な商品名は何でしょうか？放射線科医で最近は画像診断で手一杯で外来病棟を離れており、薬品名がもうぜんぜんわからなくなりました。

＞Paul Carpenterさま，ご質問ありがとうございます
亜硝酸アミルの商品名は，「亜硝酸アミル」（第一三共）でございます．
written by Paul Carpenter / 2008.07.30 09:00

コメントを書く

ニックネーム*
メールアドレス*
URL
内容*
※「利用規約」をお読みのうえ、適切な投稿をお願いします。