The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

A Case of Severe Metabolic Acidosis Associated with Sodium Hypochlorite (Bleach) Poisoning Treated by Hemodialysis

중증 대사성 산증을 동반한 차아염소산나트륨(락스) 중독 1예

  • Bae, Sung-Chang (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Moon, Sung-Jin (Department of Internal Medicine, Myongji Hospital, Kwandong University College of Medicine) ;
  • Kim, Jwa-Kyung (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Jang, Sung-Il (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Ji-Hyun (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Hyeong-Cheon (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Ha, Sung-Kyu (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • 배성창 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 문성진 (관동대학교 의과대학 명지병원 내과) ;
  • 김좌경 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 장성일 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 김지현 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 박형천 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 하성규 (연세대학교 의과대학 강남세브란스병원 내과)
  • Published : 2011.05.01
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Abstract

Sodium hypochlorite (NaOCl) is commonly used as a disinfectant or bleaching agent. The ingestion of household bleach is oftenbenign, with minimal irritating effect on the mucosa. Occasionally, however, it can be life-threatening. Here, we report an unusualcase of acute poisoning involving household bleach with a near-fatal outcome that was treated with intense hemodialysis. A42-year-old woman presented to the emergency room after ingesting 1 liter of 5% household bleach. Ten hours later, her metabolicacidosis, hypernatremia, hyperchloremia, and renal failure deteriorated gradually, despite aggressive medical treatment. Rapid, effectivecorrection of the metabolic acidosis and electrolytes imbalance was needed and hemodialysis was performed immediately.After 3 days of dialysis, the laboratory imbalance was completely corrected.

락스는 차아염소산나트륨이 주요 성분이며 락스의 중독시에는 소화기계나 호흡기계통의 합병증이 흔하게 발생하지만 가정용 락스는 알칼리 정도와 그 농도가 낮아서 대부분 장기적인 합병증은 발생하지 않으며 예후도 좋은 것으로 알려져 있다. 그러나 과량의 락스를 음독한 경우 고나트륨혈증과 고염소혈증을 동반한 심각한 대사성 산증이 발생할 수 있다. 또한 본 증례에서는 락스를 음독한 후, 초기에는 비교적 대사성 산증의 정도가 심하지 않았으나 시간이 지날수록 심각하게 악화되는 것을 보여주었다. 따라서 1 L 정도의 과량의 락스를 음독한 경우 심각한 대사성 산증의 발생에 대비한 주의 깊은 관찰이 필요하겠으며, 대사성 산증의 발생시 조기에 혈액투석을 시행하는 것이 환자의 예후를 호전시키는 데 도움이 될 것으로 생각한다.

Keywords

References

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