【発明の詳細な説明】[Detailed description of the invention]
産業上の利用分野
本発明は腎疾患患者等の透析を行なう必要のあ
る患者における透析による有害作用（副作用）防
止剤、殊にめまい及び頭痛の防止剤に関する。
従来技術とその課題
従来、腎疾患患者等に継続して透析を行なうと
その有害作用として心血管障害、全身衰弱、めま
い、頭痛等が起こることがよく知られている。と
りわけ透析時に心血管障害を起こす患者は透析困
難症とされ原因も不明のままその対策も十分にな
されていないのが現状である。透析患者の心血管
障害の一つである不整脈、心筋梗塞等の治療につ
いては現在β−遮断剤等の投与が行なわれている
がβ−遮断剤自身による副作用が問題となり使用
時に注意を要する欠点があり満足な結果は得られ
ていない。また、透析患者の死因の一つに心筋梗
塞があり、この心筋梗塞は高脂血症が原因といわ
れているため、抗高脂血剤を投与することも試み
られているがその結果も期待されるほどではな
い。
本発明は腎疾患患者等の透析患者に認められる
透析による副作用、殊にめまい及び頭痛を防止可
能な新しい医薬を提供することを目的としてなさ
れたものである。
課題を解決するための手段
上記目的はｌ−カルニチン及びその生理学的に
許容し得る塩から選ばれる少なくとも１種を有効
成分として含有し、透析患者に経口投与されるこ
とを特徴とする透析患者のめまい・頭痛防止薬に
より達成される。
本発明において有効成分とするカルニチンは、
1905年に、グレヴイツシユ（Gulewitsch）、グリ
ムベルグ（Krimberg）及びクツシヤー
（Kutscher）により、肉エキスから発見された化
合物である。1947年、フラエンケル（Fraenkel）
とルレウエツト（Rlewett）は茶色コメゴミムシ
ダマシの発育に酵母又は肝臓抽出液に含まれてい
る未知物質が必須であることを発見し、これにビ
タミンBTと命名した。その後、1952年にカルタ
ー（Carter）等は上記ビタミンBT活性を有する
結晶を分離し、これがカルニチンと同一物質であ
ることを確認した。カルニチンはヒトから微生物
にいたる広範囲の生物に分布しており、特に筋肉
や膵液中には多量に含まれていることが知られて
いる。また、その生理的、生化学的意義に関して
はフリツツ（Fritz）等による一連の研究が報告
されている［Fritz.I.B.et al.、J.Lipid.Res.、４、
279（1963）］。
カルニチン［（CH3）3N+CH2CH（OH）
CH2COO-］は生体細胞に存在するミトコンドリ
アでの脂肪酸のβ−酸化において活性型脂肪酸で
あるAcyl−CoAのミトコンドリア内への取込み
を促進する。即ち、カルニチンはAcyl−CoAカ
ルニチントランスフエラーゼの作用を介して
Acyl−カルニンチンとかえ、バリヤー
（Barrier）を速やかに通過させて内膜系でのβ−
酸化に関与させ、エネルギーの産生を助けると言
われている。従つてカルニチンはその生理作用を
利用して種々の薬理効果が期待できるが、未だこ
れを実際に透析患者に経口投与して、該患者に見
られる透析による有害作用、殊にめまいや頭痛を
予防及び治療した報告例は皆無である。
本発明は、ｌ−カルニチン又はその生理学的に
許容し得る塩を有効成分とする薬剤が、これを腎
疾患患者等の透析患者に経口投与することによ
り、該患者に認められる透析による副作用、殊に
めまい及び頭痛をみごに予防及び治療できること
を見出し完成されたものである。
本発明において有効成分とするカルニチンは、
薬理効果、治療特性の面よりｌ−カルニチンであ
ることが重要である。また本発明において有効成
分とする上記カルニチンは例えば塩酸塩等の生理
学的に許容し得る塩の形態とすることができ、本
発明の透析患者用めまい・頭痛防止薬はかかる生
理的に許容し得る塩の形態のカルニチンを有効成
分として利用することもできる。
次に本発明に用いられるｌ−カルニチンの毒性
について表により説明する。
急性毒性（LD50）
INDUSTRIAL APPLICATION FIELD The present invention relates to an agent for preventing adverse effects (side effects) caused by dialysis in patients who need to undergo dialysis, such as renal disease patients, and in particular to an agent for preventing dizziness and headache. PRIOR ART AND THEIR PROBLEMS Conventionally, it is well known that continuous dialysis in patients with renal disease causes adverse effects such as cardiovascular disorders, general weakness, dizziness, and headaches. In particular, patients who develop cardiovascular disorders during dialysis are considered to have dialysis difficulties, and as the cause remains unknown, there are currently no adequate countermeasures. β-blockers are currently being administered to treat cardiovascular disorders such as arrhythmia and myocardial infarction in dialysis patients, but the side effects of β-blockers themselves are a problem and caution must be taken when using them. However, satisfactory results have not been obtained. In addition, myocardial infarction is one of the causes of death in dialysis patients, and myocardial infarction is said to be caused by hyperlipidemia, so attempts have been made to administer antihyperlipidemic drugs, but the results are still promising. Not as much as it should. The present invention has been made with the object of providing a new medicine capable of preventing dialysis-induced side effects, particularly dizziness and headache, observed in dialysis patients such as renal disease patients. Means for Solving the Problem The above object is to provide a dialysis patient which contains at least one selected from l-carnitine and physiologically acceptable salts thereof as an active ingredient and which is orally administered to a dialysis patient. This can be achieved by using drugs to prevent dizziness and headaches. Carnitine, which is the active ingredient in the present invention, is
It is a compound discovered in meat extract by Gulewitsch, Krimberg and Kutscher in 1905. 1947, Fraenkel
and Rlewett discovered that an unknown substance contained in yeast or liver extract was essential for the growth of the brown rice beetle, and named it vitamin B T. Later, in 1952, Carter et al. isolated the above-mentioned crystals having vitamin B T activity and confirmed that this was the same substance as carnitine. Carnitine is distributed in a wide range of organisms, from humans to microorganisms, and is known to be particularly contained in large amounts in muscle and pancreatic juice. Regarding its physiological and biochemical significance, a series of studies by Fritz et al. have been reported [Fritz.IBet al., J.Lipid.Res., 4,
279 (1963)]. Carnitine [(CH 3 ) 3 N + CH 2 CH(OH)
CH 2 COO − ] promotes the uptake of Acyl-CoA, an active fatty acid, into the mitochondria during β-oxidation of fatty acids in the mitochondria present in living cells. That is, carnitine is transferred through the action of Acyl-CoA carnitine transferase.
Acyl-Carninthine is quickly passed through the barrier and β-
It is said to be involved in oxidation and help produce energy. Therefore, carnitine can be expected to have various pharmacological effects using its physiological effects, but it is still difficult to actually administer it orally to dialysis patients to prevent the adverse effects of dialysis, especially dizziness and headaches, that are seen in these patients. There are no reported cases of treatment. The present invention provides a drug containing l-carnitine or a physiologically acceptable salt thereof as an active ingredient, which can be administered orally to dialysis patients such as renal disease patients, thereby reducing side effects caused by dialysis in the patients. It was discovered and completed that it can effectively prevent and treat dizziness and headaches. Carnitine, which is the active ingredient in the present invention, is
l-carnitine is important from the viewpoint of pharmacological effects and therapeutic properties. In addition, the carnitine used as an active ingredient in the present invention can be in the form of a physiologically acceptable salt such as hydrochloride, and the anti-dizziness/headache drug for dialysis patients of the present invention can be in the form of a physiologically acceptable salt such as hydrochloride. Carnitine in salt form can also be utilized as an active ingredient. Next, the toxicity of l-carnitine used in the present invention will be explained using a table. Acute toxicity ( LD50 )
【表】
該表より、ｌ−カルニチンはその経口投与の場
合、最も毒性の低いことが明らかである。
また、その薬理効果については後の実施例によ
つて詳述するが、本発明者らは透析を実際に受け
日ごろから透析時に不整脈等の心血管障害や全身
衰弱と共に、めまい及び頭痛の苦悶を伴う患者
に、その症状等を考慮して透析前にカルニチンの
適当量を投与した所、今まで透析時には必ず発現
していためまいや頭痛の苦悶が全く認められなく
なり、日常生活も快適に過ごせるようになること
を実証できた。かかる顕著な効果が発現さる理由
は現在明確ではないが、投与されたカルニチン又
はその塩が血中脂肪酸濃度を低下させると共に長
鎖Acyl−CoAのミトコンドリア膜の通過を促進
し、心筋のエネルギー代謝を改善する作用を有す
ることと関連するものと考えられる。いずれにせ
よ上記カルニチン又はその塩は、関疾患患者の透
析時におけるめまい・頭痛の予防及び治療に優れ
た効果を発揮し、更に安全性の指標である毒性も
極めて弱く、投与による副作用も認められず、透
析患者のめまい及び頭痛防止薬として極めて有効
である。
本発明の透析患者用めまい・頭痛防止薬は通常
有効成分化合物と共に製剤的担体を利用しての投
与方法に応じた製剤組成物の形態とされる。上記
製剤的担体としては使用形態に応じた薬剤を調製
するのに通常使用される充填剤、増量剤、結合
剤、付湿剤、崩壊剤、表面活性剤、滑沢剤等の希
釈剤或は賦形剤を使用できる。また投与方法は経
口投与によるのが最も好ましい。この経口投与に
適した製剤形態としては例えば錠剤、丸剤、散
剤、液剤、顆粒剤、カプセル剤等を例示できる。
投与単位形態に製剤化された製剤組成物中の有
効成分量は特に限定されず広範囲に適宜選択され
るが、通常全組成物中１〜70重量％とするのがよ
い。また各製剤の投与量は種々の条件例えば患者
の年齢、性別、体重、疾患の重篤度等及び投与方
法等に依存するが、通常の成人では各投与回毎に
有効成分を１〜20ｇ、好ましくは２〜５ｇの範囲
で含有する製剤組成物を経口投与すればよく、投
与回数は１日１回を目安として患者の重篤度に応
じて増減すればよい。上記投与は特に透析開始数
時間前、好ましく約２時間前に行なうのが好まし
い。
実施例
次に本発明薬剤の製剤化のための実施例を示す
が、必ずしも下記の組成に限定されるものではな
い。
実施例 １
結晶セルロース 266mg
カルボキシメチルセルロース 266mg
軽質無水ケイ酸 50mg
マクロゴール6000 50mg
からなる添加剤にｌ−カルニチン又はその塩を20
〜500mg含有せしめ、顆粒、細粒、散剤を製造す
る。
実施例 ２
結晶セルロース 100mg
ステアリン酸マグネシウム ４mg
タルク ８mg
からなる添加剤にｌ−カルニチン又はその塩を50
〜500mg含有せしめカプセル剤を製造する。
実施例 ３
結晶セルロース 44mg
カルボキシメチルセルロース 44mg
乳 糖 89mg
ステアリン酸マグネシウム ３mg
タルク ５mg
からなる添加剤にｌ−カルニチン又はその塩を20
〜500mg含有せしめ、錠剤（素錠、フイルムコー
テイング錠、糖衣錠）を製造する。
実施例 ４
クエン酸 ２mg
ブドウ糖 100mg
からなる添加剤にｌ−カルニチン又はその塩を
100〜500mg／ml含有せしめ、充分量の滅菌精製水
を加えて10〜100mlのアンプル、ガラスびん又は
合成樹脂容器入り経口用液剤を製造する。
次に本発明の具体的効果について臨床例を挙げ
て詳細に説明する。
臨床例 １
この患者（40才、女性）は週３回の血液透析を
受けており、透析歴は２年７ケ月であつた。この
患者は透析を開始してしばらくすると心室性の不
整脈、更にめまい、頭痛を発現し、透析中苦悶を
訴えた。この患者の透析前の血中カルニチン濃度
は23.7nmol／mlであり、正常女子の40.5±
8.2nmol／mlより低く、透析終了時においては
28nmol／mlまで低下した。ｌ−カルニチンを毎
日２ｇ経口投与し、透析のある日には透析開始２
時間前に経口投与して透析を開始する方法により
治療を始めた。その結果、１ケ月後における透析
前の血中カルニチン濃度は189nmol／mlとなり、
終了時においては111nmol／mlであつた。また、
透析時に頻発した不整脈は１分間に５回以下に減
少し、透析中の苦悶はまつたく発現しなかつた。
自覚的にも日常の仕事を行うのに苦しさがなくな
り、気分も楽になつた。
臨床例 ２
この患者（59才、女性）は週３回の血液透析を
受けており、透析歴は３年５ケ月であつた。この
患者は透析を開始してしばらくすると上室性の不
整脈、前身衰弱、めまいが発現し、時々シヨツク
症状を呈し、透析がかなり困難な患者であつた。
従つて、透析中抗不整脈剤としてβ−遮断剤等を
使用することもしばしばであつた。この患者の透
析前の血中カルニチン濃度は19.9nmol／mlで正
常女子のカルニチン濃度の約1/2であつた。そし
て透析終了時においては0.4nmol／mlまで激減し
た。
そこで、ｌ−カルニチンを毎日２ｇ経口投与
し、透析のある日には透析を開始する２時間前に
経口投与する方法で治療を始めた。その結果、１
ケ月後における透析前の血中カルニチン濃度は
329nmol／mlとなり、終了時においては
157nmol／mlであつた。また、透析中に発現して
いたシヨツク症状、前身衰弱、めまいはまつたく
なくなり、頻発していた不整脈の発生もまつたく
認めなくなつた。そして日常生活も快適にすごせ
るようになつた。
臨床例 ３
この患者（63才、女性）は週３回の血液透析受
けており、透析歴は９ケ月であつた。この患者は
透析を開始してしばらくして心室性の不整脈並び
にめまい、頭痛を発現し、時々不安感を訴えた。
この患者の透析前の血中カルニチン濃度は
19.9nmol／mlで正常女子のカルニチン濃度の約
１／２であり、透析終了時においては8.7nmol／ml
まで減少した。そこで、ｌ−カルニチンを毎日２
ｇ経口投与し、透析日には透析の２時間前に経口
投与する方法で治療を始めた。１ケ月後における
透析前の血中カルニチン濃度は68nmol／mlとな
り、終了時には60nmol／mlであつた。また１分
間毎約８回発生していた不整脈は１回以下まで減
少した。そしてめまい、頭痛等もなくなり、透析
中の不安感はなくなつた。
臨床例 ４
この患者（54才、男性）は週３回、血液透析を
受けており、透析歴は１年４ケ月であつた。患者
は透析を開始して、しばらくすると心室性の不整
脈及びめまいを併発し、時々不安感を訴えた。患
者の透析前の血中カルニチン濃度は32.3nmol／
mlで正常男子の51.8±6.5nmol／mlより低く、透
析終了時においては10.5nmol／mlまで減少した。
そこでｌ−カルニチンを毎日２ｇ経口投与し、透
析日には透析の２時間前に経口投与する方法で治
療を始めた。その結果、１ケ月後における透析前
の血中カルニチン濃度は190nmol／mlとなり、終
了時においては136nmol／mlであつた。また、透
析中１分間約８回発生していた不整脈はまつたく
認められなくなり、めまいも等なくなつた。自覚
的にも不安感はなくなり、気分が楽になつた。
臨床例 ５
この患者（35才、女性）は週３回の血液透析受
けており、透析歴は３年７ケ月であつた。この患
者は透析中しばしば心室性の不整脈を発生し、ま
た全身衰弱、めまい、頭痛を併発した。患者の透
析前の血中カルニチン濃度は32.4nmol／mlで正
常女子のカルニチン濃度よりも低かつた。そして
透析終了時においては5.9nmol／mlまで抵下し
た。そこでｌ−カルニチン２ｇを透析日のみに限
り、透析開始２時間前に経口投与することで治療
を始めたところ、２ケ月後における透析前の血中
カルニチン濃度は68nmol／mlとなり、終了時に
おいて51mol／mlであつた。また、透析中に頻発
した不整脈は１分間に約10回程度になり、また前
身衰弱、めまい、頭痛もなくなり、不安感は解消
された。
臨床例 ６
この患者（49才、男性）は週３回の血液透析受
けており、透析歴は５年７ケ月である。この患者
は透析中にしばしば不整脈、頭痛を発現し、苦悶
を訴えた。患者の透析前の血中カルニチン濃度は
35.4nmol／mlであり、正常男子よりも低く、透
析終了時には20.1nmol／mlまで低下した。そこ
でｌ−カルニチン２ｇを透析時のみに限り、透析
開始２時間前に経口投与を行なつた。その結果、
２ケ月後における透析前の血中カルニチン濃度は
98nmol／mlとなり、終了時においては54nmol／
mlであつた。また、透析中１分間に約７回発生し
た不整脈は１分間に２回以下となり、頭痛もなく
なつた。そして日常生活も快適にすごせるように
なつた。
臨床例 ７
患者（58才、女性）は週３回の血液透析を受け
ており、透析歴は４年８ケ月であつた。この患者
は透析を開始してしばらくすると、心室性の不整
脈が発生し、更にめまい、頭痛を併発した。患者
の透析前の血中カルニチン濃度は28.1nmol／ml
であり、正常女子よりも低く、透析終了時には
18.6nmol／mlまで低下した。そこでこの患者に
ｌ−カルニチン２ｇを透析日のみに限り、透析開
始２時間前に経口投与した。２ケ月後における透
析前の血中カルニチン濃度は138nmol／mlとな
り、終了時には121nmol／mlであつた。また透析
時１分間５回発生していた不整脈は減少し、１分
間に２〜３回となつた。そしてめまい、頭痛もな
くなり、不安感は解消された。
臨床例 ８
この患者（63才、男性）は週３回の血液透析を
受けており、透析歴は５年である。この患者は透
析を開始してしばらくすると上室性の不整脈を発
生し、更に全身衰弱、めまい等を訴え苦悶した。
患者の透析前の血中カルニチン濃度は
34.4nmol／mlであり正常男子よりも低く、透析
終了時には18.1nmol／mlまで低下した。そこで
この患者にｌ−カルニチン２ｇを透析日のみに限
り、透析開始２時間前に経口投与をした。２ケ月
後における透析前の血中カルニチン濃度は
69nmol／mlとなり、終了時には30nmol／mlまで
の低下であつた。また透析中１分間約５回発生し
ていた不整脈は１分間約１回以下となり、同時に
全身衰弱、めまい等もなくなり、その後の透析も
楽になつた。自覚的にも気分が楽になり、日常生
活の不安も解消され、快適にすごせるようになつ
た。[Table] From the table, it is clear that l-carnitine has the lowest toxicity when administered orally. In addition, although its pharmacological effects will be explained in detail in later examples, the present inventors have actually experienced dialysis and experienced cardiovascular disorders such as arrhythmia and general weakness during dialysis, as well as dizziness and headaches. When we administered an appropriate amount of carnitine to patients with dialysis before dialysis, taking their symptoms into account, the dizziness and headaches that always occurred during dialysis disappeared, and they were able to live comfortably in their daily lives. I was able to prove that it does. Although the reason for such a remarkable effect is currently not clear, administered carnitine or its salts reduce blood fatty acid concentration and promote the passage of long-chain Acyl-CoA through the mitochondrial membrane, thereby improving myocardial energy metabolism. This is thought to be related to the fact that it has an improving effect. In any case, the above-mentioned carnitine or its salts exhibit excellent effects in the prevention and treatment of dizziness and headaches during dialysis in patients with related diseases, and also have extremely low toxicity, which is an indicator of safety, and no side effects are observed when administered. It is extremely effective as a drug for preventing dizziness and headaches in dialysis patients. The dizziness/headache prevention drug for dialysis patients of the present invention is usually in the form of a pharmaceutical composition that utilizes a pharmaceutical carrier together with the active ingredient compound depending on the method of administration. The above-mentioned pharmaceutical carriers include fillers, fillers, binders, wetting agents, disintegrants, surface active agents, diluents such as lubricants, etc., which are commonly used to prepare drugs according to the usage form. Excipients can be used. Also, the most preferred method of administration is oral administration. Examples of dosage forms suitable for oral administration include tablets, pills, powders, liquids, granules, and capsules. The amount of the active ingredient in the pharmaceutical composition formulated into a dosage unit form is not particularly limited and can be appropriately selected within a wide range, but it is usually 1 to 70% by weight of the total composition. The dosage of each preparation depends on various conditions such as the patient's age, sex, weight, severity of disease, etc., and the method of administration, but for a typical adult, 1 to 20 g of the active ingredient is administered each time. Preferably, a pharmaceutical composition containing 2 to 5 g may be orally administered, and the frequency of administration may be increased or decreased depending on the patient's severity, with the aim of administering once a day. The above administration is preferably carried out several hours, preferably about 2 hours, before the start of dialysis. Examples Next, examples for preparing the pharmaceutical composition of the present invention will be shown, but the compositions are not necessarily limited to the following compositions. Example 1 Additives consisting of 266 mg of crystalline cellulose, 266 mg of carboxymethyl cellulose, 50 mg of light anhydrous silicic acid, and 50 mg of macrogol 6000 were added with 20 mg of l-carnitine or its salt.
Produce granules, fine granules, and powders containing ~500 mg. Example 2 Additives consisting of 100 mg of crystalline cellulose, 4 mg of magnesium stearate, and 8 mg of talc were added with 50 mg of l-carnitine or its salt.
Produce seshime capsules containing ~500mg. Example 3 Additives consisting of 44 mg of crystalline cellulose, 44 mg of carboxymethyl cellulose, 89 mg of lactose, 3 mg of magnesium stearate, and 5 mg of talc were added with 20 mg of l-carnitine or its salt.
Manufacture tablets (uncoated tablets, film-coated tablets, sugar-coated tablets) containing ~500 mg. Example 4 l-carnitine or its salt was added to an additive consisting of 2 mg of citric acid and 100 mg of glucose.
A sufficient amount of sterile purified water is added to produce an oral liquid preparation containing 100 to 500 mg/ml in a 10 to 100 ml ampoule, glass bottle, or synthetic resin container. Next, specific effects of the present invention will be explained in detail using clinical examples. Clinical Case 1 This patient (40 years old, female) was undergoing hemodialysis three times a week, and her dialysis history was 2 years and 7 months. Shortly after starting dialysis, this patient developed ventricular arrhythmia, dizziness, and headache, and complained of agony during dialysis. This patient's blood carnitine concentration before dialysis was 23.7 nmol/ml, compared to 40.5 ±
Lower than 8.2nmol/ml, at the end of dialysis
It decreased to 28 nmol/ml. Administer 2g of l-carnitine orally every day, and start dialysis on the day of dialysis.
Treatment was started by orally administering the drug before the start of dialysis. As a result, one month later, the blood carnitine concentration before dialysis was 189 nmol/ml.
At the end, it was 111 nmol/ml. Also,
The arrhythmia that frequently occurred during dialysis was reduced to less than 5 times per minute, and no distress occurred during dialysis.
I was consciously aware that I no longer felt any pain in doing my daily tasks, and I felt more at ease. Clinical Case 2 This patient (59 years old, female) was undergoing hemodialysis three times a week, and had been on dialysis for 3 years and 5 months. Shortly after starting dialysis, this patient developed supraventricular arrhythmia, anterior weakness, dizziness, and occasional symptoms of shock, making dialysis extremely difficult.
Therefore, β-blockers and the like have often been used as antiarrhythmic agents during dialysis. This patient's blood carnitine concentration before dialysis was 19.9 nmol/ml, which was approximately 1/2 of the carnitine concentration in a normal female. At the end of dialysis, the concentration decreased sharply to 0.4 nmol/ml. Therefore, treatment was started by orally administering 2 g of l-carnitine every day, and on days of dialysis, administering it orally 2 hours before starting dialysis. As a result, 1
The blood carnitine concentration before dialysis after 2 months is
329nmol/ml, and at the end of the
It was 157 nmol/ml. In addition, the symptoms of shock, weakness, and dizziness that had occurred during dialysis disappeared, and the frequent occurrence of arrhythmia also disappeared. And now I can live my daily life more comfortably. Clinical Case 3 This patient (63 years old, female) was undergoing hemodialysis three times a week, and her dialysis history was 9 months. Shortly after starting dialysis, this patient developed ventricular arrhythmia, dizziness, and headache, and occasionally complained of anxiety.
This patient's blood carnitine concentration before dialysis was
The carnitine concentration is 19.9nmol/ml, which is about 1/2 of that of a normal female, and 8.7nmol/ml at the end of dialysis.
decreased to Therefore, l-carnitine should be taken twice daily.
Treatment was started by administering the drug orally, and on the day of dialysis, administering it orally 2 hours before dialysis. One month later, the blood carnitine concentration before dialysis was 68 nmol/ml, and at the end of the dialysis it was 60 nmol/ml. Additionally, the number of arrhythmias that occurred approximately eight times per minute was reduced to less than one. Also, my dizziness and headaches disappeared, and I no longer felt anxious during dialysis. Clinical Case 4 This patient (54 years old, male) was undergoing hemodialysis three times a week, and had been on dialysis for 1 year and 4 months. After starting dialysis, the patient developed ventricular arrhythmia and dizziness, and occasionally complained of anxiety. The patient's blood carnitine concentration before dialysis was 32.3 nmol/
ml was lower than that of normal males, 51.8±6.5 nmol/ml, and decreased to 10.5 nmol/ml at the end of dialysis.
Therefore, treatment was started by orally administering 2 g of l-carnitine every day, and on dialysis days, 2 hours before dialysis. As a result, the blood carnitine concentration before dialysis after one month was 190 nmol/ml, and at the end of dialysis it was 136 nmol/ml. Additionally, the arrhythmia that had occurred approximately 8 times per minute during dialysis disappeared, and the patient no longer felt dizzy. I felt less anxious and felt more at ease. Clinical Case 5 This patient (35 years old, female) was undergoing hemodialysis three times a week, and her dialysis history was 3 years and 7 months. This patient frequently developed ventricular arrhythmia during dialysis, as well as generalized weakness, dizziness, and headache. The patient's blood carnitine concentration before dialysis was 32.4 nmol/ml, which was lower than that of normal women. At the end of dialysis, the concentration decreased to 5.9 nmol/ml. Therefore, treatment was started by orally administering 2 g of l-carnitine only on dialysis days, 2 hours before the start of dialysis, and after 2 months, the blood carnitine concentration before dialysis was 68 nmol/ml, and at the end of dialysis it was 51 mol/ml. /ml. In addition, the arrhythmia that occurred frequently during dialysis has decreased to about 10 times per minute, and the weakness, dizziness, and headaches have disappeared, and the patient's anxiety has disappeared. Clinical Case 6 This patient (49 years old, male) undergoes hemodialysis three times a week, and his dialysis history is 5 years and 7 months. During dialysis, this patient frequently developed arrhythmia, headache, and complained of distress. The patient's blood carnitine concentration before dialysis is
It was 35.4 nmol/ml, lower than that of normal boys, and decreased to 20.1 nmol/ml at the end of dialysis. Therefore, 2 g of l-carnitine was orally administered only during dialysis, 2 hours before the start of dialysis. the result,
Two months later, the blood carnitine concentration before dialysis was
98nmol/ml, and 54nmol/ml at the end of the process.
It was hot in ml. Furthermore, the arrhythmia that occurred approximately 7 times per minute during dialysis decreased to less than 2 times per minute, and the patient's headaches disappeared. And now I can live my daily life more comfortably. Clinical Case 7 A patient (58 years old, female) was undergoing hemodialysis three times a week, and her dialysis history was 4 years and 8 months. Shortly after starting dialysis, this patient developed ventricular arrhythmia, which was accompanied by dizziness and headache. The patient's blood carnitine concentration before dialysis was 28.1 nmol/ml.
and lower than that of normal women, and at the end of dialysis
It decreased to 18.6 nmol/ml. Therefore, 2 g of l-carnitine was orally administered to this patient only on the day of dialysis, 2 hours before the start of dialysis. Two months later, the blood carnitine concentration before dialysis was 138 nmol/ml, and at the end of the dialysis it was 121 nmol/ml. In addition, arrhythmia, which occurred 5 times per minute during dialysis, decreased to 2 to 3 times per minute. My dizziness and headaches disappeared, and my anxiety disappeared. Clinical Case 8 This patient (63 years old, male) receives hemodialysis three times a week, and has a history of 5 years of dialysis. Shortly after starting dialysis, this patient developed supraventricular arrhythmia, and also complained of general weakness, dizziness, etc., and was in agony.
The patient's blood carnitine concentration before dialysis is
It was 34.4 nmol/ml, lower than that of normal males, and decreased to 18.1 nmol/ml at the end of dialysis. Therefore, 2 g of l-carnitine was orally administered to this patient only on the day of dialysis, 2 hours before the start of dialysis. Two months later, the blood carnitine concentration before dialysis was
The concentration was 69 nmol/ml, which had decreased to 30 nmol/ml at the end of the process. In addition, the arrhythmia that occurred about 5 times per minute during dialysis decreased to less than about 1 per minute, and at the same time, general weakness and dizziness disappeared, making subsequent dialysis easier. I felt more consciously at ease, my anxiety about daily life disappeared, and I was able to live comfortably.