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Journal of the Korean Geriatrics Society 2004;8(1):47-50.
Published online March 31, 2004.
Status Epilepticus after Mye lography with Inadve rtent Injection of Diatrizoate
Hui Chul Choi, Sang Moo Lee, Jong Hee Son
Department of Neurology, Hallym University College of Medicine, Chunchun, Korea. dohchi@hallym.ac.kr
오용(誤用)된 Diatrizoate 척수 조영술 후 발생한 간질중첩증
Abstract
A 37-year-old male patient was transferred from a local orthopedic clinic due to status epilepticus following a myelography with diatrizoate. On his laboratory findings, metabolic acidosis was prominent. Non-enhanced brain CT scan showed a high densinty in the subarchnoid space. With careful respiratory support, hydration, correction of acid-base balance, administration of dexamethasone, and anticonvulsant therapy, he completely recovered after 3 days. Diatrizoate is an ionic, iodinated and hyperosmolar X-ray contrast medium. It must not be injected intrathecally because of the risk to the central nervous system. The possible mechanisms are anaphylactic reaction due to iodine hypersensitivity, hyperosmolar effect, and direct chemotoxicity by ionicity and chemical structure itself.
Key Words: Diatrizoate, Status epilepticus, Myelography, Intrathecal injection
초 록

Diatrizoate와 같은 이온성 고삼투압 조영제는 동맥조영술, 정맥조영술, 요로조영술 및 컴퓨터전산화 단층촬영의 조영 증강을 위해 사용되나 척수조영술에는 사용되지 않는다. 잘못하여 Diatrizoate로 척수조영술을 시행한다면 대사성 산증과 탈수가 생기고, 중추신경계 독성으로 인한 간질중첩증이 발생되고, 이로 인한 횡문근융해증이 나타난다. 이런 결과 환자는 신부전, 심부전 및 다장기 부전증으로 사망하게 된다. 만약 이런 부적절한 사고가 발생하면 대사성 산증과 탈수를 조절하고 중첩성간질에 대한 적절한 치료가 이뤄져야 한다. 그러나 무엇보다 중요한 것은 조영제의 정확한 용도와 용량을 지키는 것이고, 혹시라도 잘못된 사용이 있었다면 조영제의 특성을 잘 파악하여 적절한 치료를 하는 것이다.

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