Kikuchi Satoshi, Fujita Yuji, Onodera Makoto, Fujino Yasuhisa, Inoue Yoshihiro
Department of Emergency Medicine Iwate Medical University School of Medicine Morioka Iwate Japan.
Poisoning and Drug Laboratory Division, Critical Care and Emergency Center Iwate Medical University Hospital Morioka Iwate Japan.
Acute Med Surg. 2016 Mar 28;3(4):384-387. doi: 10.1002/ams2.196. eCollection 2016 Oct.
A 47-year-old man ingested 60 mL of a topical solution (3,000 mg minoxidil) and presented with prolonged hypotension. Treatment with dopamine hydrochloride and noradrenaline provided blood pressure control. Serum unchanged minoxidil concentrations at 4 and 16 h after ingestion were 4,994 and 33.9 ng/mL, respectively. Urine concentrations of unchanged minoxidil, minoxidil--glucuronide, and minoxidil---sulfate at 16 h after ingestion were 360.4, 1,953, and 104.5 ng/mL, respectively.
The serum unchanged minoxidil concentration rapidly decreased over a short interval. However, the patient needed to receive vasopressor support for the first 4 days after being admitted to the hospital. The urine minoxidil--glucuronide concentration was higher than the concentrations of unchanged minoxidil and minoxidil---sulfate.
Although the serum concentration of unchanged minoxidil rapidly decreased, ingesting large amounts of a topical minoxidil solution can have serious and prolonged cardiovascular effects. Analyzing the minoxidil--glucuronide concentration in urine is useful for diagnosing minoxidil poisoning.
一名47岁男性摄入了60毫升外用溶液（3000毫克米诺地尔），并出现了长时间的低血压。使用盐酸多巴胺和去甲肾上腺素进行治疗后血压得到控制。摄入后4小时和16小时血清中未代谢米诺地尔的浓度分别为4994纳克/毫升和33.9纳克/毫升。摄入后16小时尿液中未代谢米诺地尔、米诺地尔 - 葡糖醛酸苷和米诺地尔 - 硫酸盐的浓度分别为360.4纳克/毫升、1953纳克/毫升和104.5纳克/毫升。
血清中未代谢米诺地尔的浓度在短时间内迅速下降。然而，患者在入院后的前4天需要接受血管升压药支持。尿液中米诺地尔 - 葡糖醛酸苷的浓度高于未代谢米诺地尔和米诺地尔 - 硫酸盐的浓度。
尽管血清中未代谢米诺地尔的浓度迅速下降，但摄入大量外用米诺地尔溶液可能会产生严重且持久的心血管影响。分析尿液中米诺地尔 - 葡糖醛酸苷的浓度有助于诊断米诺地尔中毒。
