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Chlorpromazine Induced Severe Cholestasis in Dialysis Patient
Chlorpromazine在血液透析病患引起嚴重之膽汁滯留：一病例報告
摘要
一位六十三歲的女性血液透析病患使用Chlorpromazine二個月後引起嚴重之黃疸及皮膚搔癢。她沒有B型及C型肝炎且常見之自體抗體檢查均為陰性。腹部超音波只顯示中度脂肪肝，厚膽囊壁，而無膽道擴張。即使Chlorpromazine於住院後已停用，但膽紅素指數仍高達23.8mg/dL。為了探討逐步升高之黃疸指數，安排了經皮肝穿刺檢查。肝穿刺病理顯示退化性及脂肪化之肝細胞，此外中央靜脈附近之肝細胞間有膽汁滯留。這是一位血液透析病患使用chlorpromazine後所導致之膽汁滯留，但不同於一般腎功能正常病人，它所引起黃疸之程度及病程都較為嚴重。這篇報告提醒在使用chlorpromazine於血液透析病患時要特別小心。
並列摘要
A 63-year-old woman, with end-stage renal disease (ESRD) on maintenance hemodialysis who had received chlorpromazine for 2 months, was admitted because of progressive jaundice and severe skin itching for one week. Serologic tests for viral hepatitis B and C were negative. The anti-nuclear antibody, anti-smooth muscle antibody, and anti-mitochondria antibody were all negative. The abdominal sonography disclosed moderate fatty liver, and gall bladder wall thickness without biliary tract dilatation. However, the peak level of total bilirubin reached 23.8 mg/dL and occurred in the sixteenth day after discontinuing chlorpromazine. Percutaneous liver biopsy was performed to evaluate the soaring bilirubin level. The liver biopsy revealed degeneration and fatty change in hepatocytes, intracellular and intracanalicular cholestasis around the central vein. We reported a chlorpromazine-induced cholestasis in a patient with maintenance hemodialysis. The clinical course of cholestasis was more severe and prolonged than patients with normal renal function. This report suggests chlorpromazine should be prescribed to dialysis patients with extreme caution.