Abstract
We report a rare case of a patient who developed syndrome malin (SM) during maintenance hemodialysis.
A 42-year-old man, for whom maintenance hemodialysis was being been performed for diabetic nephropathy, was admitted to the hospital because of high fever, nystagums, tremor and hallucinations. On the blood examination, the GOT was 459IU/l, LDH 1, 669IU/l, CPK 529IU/l, aldolase 13.3mU/ml, myoglobin 3, 200ng/ml, and an arterial blood gas examination revealed severe hypoxemia (PO2 27.1mmHg, PCO2 42.8mmHg). At that time he had been prescribed metoclopramide hydrocloride (30mg/day) orally, which is often used for the control of nausea, for five months. The symptoms of hyperthermia, autonomic instability, extrapyramidal signs and altered consciousness were consistent with a diagnosis of syndrome malin.
Accordingly we withdrew the metoclopramide and performed extraemoialysis therapy. The symptoms then rapidly improved and the patient made a rapid recovery.
