一位過量飲酒者之多次暈厥與猝死
李燕鳴1,2 張寶源3
暈厥是急診或住院的常見病徵，不同病因的預後差異很大。低血鉀症、心律不整、心律異常、心肌缺氧/梗窒、衰竭或結構性心臟病是心因型暈厥的常見病因。一位38歲男士因多次暈厥到家庭醫學科門診求診，病史有無症狀先天性心臟病；無常規用藥，家族無猝死病史。理學檢查發現坐姿血壓高（149/90 mmHg, 右臂）、心律過速（脈膊112/分鐘）、收縮期心雜音（2-3度）。心電圖發現QT間距(interval)延長(QTc=522 msec)，實驗室檢驗發現嚴重的低血鉀症(K＋2.5 mmol/L)，輕度肝功能上升(asparatate aminotransferase 145 IU/L, alanine aminotransferase ALT 47 IU/L, gamma glutamyl transferase 959 IU/L)、貧血(hemoglobin, Hb 11.7 g/dL)和血小板低下(62000 /μL)。自國中時開始有吸菸、嚼檳榔、飲酒習慣、近期每天飲啤酒3-4罐。轉心臟科診治，在心室過速心律不整的診斷後安排入院治療，在住院第4天出現血便和Hb下降(8.9 g/dL)，在住院第6天血鉀回升至K＋3.0 mmol/L，2天後出院繼續以口服藥物治療，在一週後曾到心臟科門診複診，當天檢驗結果K＋3.2 mmol/L和Hb 11.5 g/dL；在10天後早上被家人發現無生命徵狀。本文整理和討論這位病人的實驗室檢驗，探討過量飲酒對健康的不良影響。
（台灣家醫誌2020; 30: 235-242）DOI: 10.3966/168232812020123004005
1花蓮慈濟醫院家庭醫學科、
3影像醫學科；
2慈濟大學護理學系
受理日期：109年4月30日 修改日期：109年6月4日 同意刊登：109年7月6日
通訊作者：張寶源 通訊地址：970花蓮市中央路三段707號 E-mail:
yinming@mail.tcu.edu.tw
Frequent Syncopal Episodes and Sudden Death of a Man
with Heavy Alcohol Use: A Case Report
Yin-Ming Li1,2 and Po-Yu Chang3
Syncope is a common cause of medical visit or hospitalization. Its prognosis is largely unpredictable, depending on the origin of the sudden loss of consciousness. Reporting a much higher mortality rate than its non-cardiac counterpart, cardiac syncope finds its major causes in hypokalemia, cardiac arrhythmia, ischemia/infarction, heart failure or structural cardiac disease. A 38-year-old man presented with recurrent syncope visited our family medicine out-patient clinic. He had a history of asymptomatic congenital heart disease and no current medication. There was no significant family history. With physical examination, high blood pressure (right arm 149/90 mmHg) at sitting position and tachycardia (pulse rate 112/min) and systolic heart murmur (grade 2-3) were noted. The 12-lead ECG revealed prolonged QT (QTc=522 msec). Laboratory investigation showed severe hypokalemia (K+ 2.5 mmol/L), elevated liver enzymes (aspartate aminotransferase 145 IU/L, alanine aminotransferase 47 IU/L, gamma glutamyl transferase 959 IU/L), anemia (hemoglobin 11.7g/dL) and thrombocytopenia (platelet count 62000/μL). The patient had smoked, chewed betel nuts, and drunk wine since late adolescence. Current alcohol consumption was 3-4 cans of beer daily. He was transferred to cardiologist and admitted to the cardiac ward due to suspected diagnosis of ventricular tachycardia. Bloody stool was noted and hemoglobin dropped to 8.9 g/L on Day 4 of hospitalization, and serum K+ corrected to 3.0 mmol/L by Day 6. He was discharged with oral prescription 2 days after. The patient returned to the cardiology clinic for follow-up one week later, when laboratory test revealed serum K+ 3.2 mmol/L and hemoglobin 11.5 g/dL. He was found dead in the morning 10 days after. We reported and discussed the findings of this patient's investigation with a focus on studying the adverse health effects of heavy alcohol use.
(Taiwan J Fam Med 2020; 30: 235-242) DOI: 10.3966/168232812020123004005
Key words: heavy alcohol use, hypokalemia, long QT syndrome, sudden death
1Departments of Family Medicine,
3Radiology, Tzu Chi General Hospital; 2Department of Nursing, Tzu Chi University, Hualien, Taiwan.
Received: April 30, 2020; Revised: June 4, 2020; Accepted: July 6, 2020.
