Biomedical Department of Internal and Specialist Medicine, Policlinico Paolo Giaccone, University Hospital of Palermo, Palermo, Italy.
Am J Ther. 2010 Jul-Aug;17(4):e133-4. doi: 10.1097/MJT.0b013e3181baf253.
We report the case of an elderly patient with diastolic heart failure and renal insufficiency admitted to hospital as he complained of having a history of hypogastric pain and dysuria without fever due to renal lithiasis and urinary infection. Because the pain was persistence, and considering the presence of renal dysfunction, it was administered a single low dose of paracetamol/codein (500/30 mg). After about 1 hour of the administration, he suddenly complained of the onset of a lancinating epigastric pain radiating to the whole abdomen and retrosternum accompanied by nausea. The electrocardiogram (EKG) was negative for myocardial infarction and computed tomography excluded aortic dissection and other causes of acute abdomen. Laboratory tests showed instead liver and pancreatic damage. The symptomatology was relieved 3 hours later of the onset after antispastic treatment with anticholinergics (floroglucine). The likely underlying pathophysiological mechanism is the codein-induced spasm of the sphincter of Oddi combined with dysfunction of the same sphincter and reduced bile storage capacity related to a previous cholecystectomy. When a similar event does not regress, it may lead to more severe conditions such as acute pancreatitis. Since codein is a widely used drug, this report may suggest cholecystectomy as a contraindication during administration for the risk of occurrence of these complications.
我们报告了一例老年患者的病例，该患者患有舒张性心力衰竭和肾功能不全，因肾结石和尿路感染导致下腹痛和尿痛而无发热，故入院。由于疼痛持续存在，且考虑到肾功能不全，给予了单次低剂量的对乙酰氨基酚/可待因（500/30 毫克）。给药后约 1 小时，他突然抱怨出现了一阵尖锐的上腹痛，放射到整个腹部和后胸骨，并伴有恶心。心电图（EKG）排除了心肌梗塞，计算机断层扫描排除了主动脉夹层和其他急性腹痛的原因。实验室检查显示肝和胰腺损伤。在使用抗胆碱能药物（氟罗葡萄糖）进行解痉治疗 3 小时后，症状缓解。潜在的病理生理机制可能是可待因引起的 Oddi 括约肌痉挛，加上同一括约肌功能障碍和与先前胆囊切除术相关的胆汁储存能力降低。如果类似的症状没有消退，可能会导致更严重的情况，如急性胰腺炎。由于可待因是一种广泛使用的药物，因此该报告可能表明在使用时存在胆囊切除术的禁忌证，因为存在发生这些并发症的风险。
