塗膜剥離剤の吸入により急性ベンジルアルコール中毒を来した1例(A case of benzyl alcohol poisoning by inhalation of paint stripper)

症例は45歳の男性で，バイオハクリX–WB®（ベンジルアルコール34.8%含有）を用いた，塗膜剥離作業中に意識障害を来し，救急搬送された。来院時のバイタルサインはGCS E1V1M1，呼吸数24/min，血圧114/82mmHg，脈拍 104/min，SpO298%であった。気管挿管し人工呼吸管理を開始した。血圧低下，進行性の代謝性アシドーシスと尿細管障害による多尿を認めたが，対症療法で対応した。第2病日には意識レベル改善，血圧低下や代謝性アシドーシスも自然軽快し，抜管した。身体症状は順調に改善したが，高次機能障害は遷延した。第24病日に独歩退院した。臨床症状と尿中馬尿酸が高値であったことから，吸入曝露によるベンジルアルコール中毒と診断した。後日，ベンジルアルコールの血中濃度を解析し，診断を確定した。ベンジルアルコール中毒は成人での報告は稀である。意識障害，低血圧，代謝性アシドーシス，腎障害などの重篤な症状を来すが，特異的な治療法はなく，集中治療室で対症的に全身管理を行う必要がある。 A 45–year–old man was transported to our hospital with a consciousness disturbance that developed when he was at work paint–peeling using Baiohakuri–X–WB®(containing 34.8% benzyl alcohol). Upon admission, his Glasgow coma scale score was E1V1M1, respiratory rate was 24breaths/min, blood pressure was 114/82mmHg, pulse rate was 104 beats/min, and SpO2was 98%. He was intubated immediately, and received mechanical ventilation. His blood pressure dropped, and progressive metabolic acidosis and polyuria were detected, but he responded to symptomatic treatment. On the hospital day 2, his consciousness level, hypotension, and metabolic acidosis improved, and he was extubated. His physical symptoms recovered steadily, but higher brain dysfunction persisted. On the hospital day 24, he could walk independently and was discharged. The patient exhibited major clinical symptoms and high urinary hippuric acid levels; therefore, he was diagnosed with benzyl alcohol poisoning due to inhalation exposure. Subsequently, his blood concentration of benzyl alcohol was analyzed, and the diagnosis was confirmed. Benzyl alcohol poisoning is rare in adults. It causes serious symptoms such as consciousness disorder, hypotension, metabolic acidosis, and renal disorders, and there is no specific treatment; thus, it is necessary to perform systemic management symptomatically in the intensive care unit.