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WordNet

street name for lysergic acid diethylamide (同)back breaker, battery-acid, dose, dot, Elvis, loony toons, Lucy in the sky with diamonds, pane, superman, window pane, Zen
any of various water-soluble compounds having a sour taste and capable of turning litmus red and reacting with a base to form a salt
having the characteristics of an acid; "an acid reaction"

PrepTutorEJDIC

酸性の / 酸味のある,すっぱい(sour) / (言葉・態度などが)厳しい,しんらつな / 酸 / すっぱいもの / 《俗》=LSD

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/02/06 11:55:22」(JST)

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This article is about acids in chemistry. For the drug, see Lysergic acid diethylamide. For other uses, see Acid (disambiguation).

"Acidity" redirects here. For the novelette, see Acidity (novelette).

Zinc, a typical metal, reacting with hydrochloric acid, a typical acid

An acid (from the Latin acidus/acēre meaning sour^[1]) is a chemical substance whose aqueous solutions are characterized by a sour taste, the ability to turn blue litmus red, and the ability to react with bases and certain metals (like calcium) to form salts. Aqueous solutions of acids have a pH of less than 7. A lower pH means a higher acidity, and thus a higher concentration of hydrogen ions in the solution. Chemicals or substances having the property of an acid are said to be acidic.

Common examples of acids include hydrochloric acid (a solution of hydrogen chloride which is found in gastric acid in the stomach and activates digestive enzymes), acetic acid (vinegar is a dilute solution of this liquid), sulfuric acid (used in car batteries), and tartaric acid (a solid used in baking). As these examples show, acids can be solutions or pure substances, and can be derived from solids, liquids, or gases. Strong acids and some concentrated weak acids are corrosive, but there are exceptions such as carboranes and boric acid.

There are three common definitions for acids: the Arrhenius definition, the Brønsted-Lowry definition, and the Lewis definition. The Arrhenius definition defines acids as substances which increase the concentration of hydrogen ions (H⁺), or more accurately, hydronium ions (H₃O⁺), when dissolved in water. The Brønsted-Lowry definition is an expansion: an acid is a substance which can act as a proton donor. By this definition, any compound which can easily be deprotonated can be considered an acid. Examples include alcohols and amines which contain O-H or N-H fragments. A Lewis acid is a substance that can accept a pair of electrons to form a covalent bond. Examples of Lewis acids include all metal cations, and electron-deficient molecules such as boron trifluoride and aluminium trichloride.

1 Definitions and concepts
- 1.1 Arrhenius acids
- 1.2 Brønsted-Lowry acids
- 1.3 Lewis acids
2 Dissociation and equilibrium
3 Nomenclature
4 Acid strength
5 Chemical characteristics
- 5.1 Monoprotic acids
- 5.2 Polyprotic acids
- 5.3 Neutralization
- 5.4 Weak acid–weak base equilibrium
6 Applications of acids
- 6.1 Acid catalysis
7 Biological occurrence
8 Common acids
- 8.1 Mineral acids (inorganic acids)
- 8.2 Sulfonic acids
- 8.3 Carboxylic acids
- 8.4 Halogenated carboxylic acids
- 8.5 Vinylogous carboxylic acids
- 8.6 Nucleic acids
9 References
10 External links

Definitions and concepts[edit]

Main article: Acid–base reaction

Modern definitions are concerned with the fundamental chemical reactions common to all acids.

Most acids encountered in everyday life are aqueous solutions, or can be dissolved in water, so the Arrhenius and Brønsted-Lowry definitions are the most relevant.

The Brønsted-Lowry definition is the most widely used definition; unless otherwise specified, acid-base reactions are assumed to involve the transfer of a proton (H⁺) from an acid to a base.

Hydronium ions are acids according to all three definitions. Interestingly, although alcohols and amines can be Brønsted-Lowry acids, they can also function as Lewis bases due to the lone pairs of electrons on their oxygen and nitrogen atoms.

Arrhenius acids[edit]

Svante Arrhenius

The Swedish chemist Svante Arrhenius attributed the properties of acidity to hydrogen ions (H⁺) or protons in 1884. An Arrhenius acid is a substance that, when added to water, increases the concentration of H⁺ ions in the water. Note that chemists often write H⁺(aq) and refer to the hydrogen ion when describing acid-base reactions but the free hydrogen nucleus, a proton, does not exist alone in water, it exists as the hydronium ion, H₃O⁺. Thus, an Arrhenius acid can also be described as a substance that increases the concentration of hydronium ions when added to water. This definition stems from the equilibrium dissociation of water into hydronium and hydroxide (OH⁻) ions:^[2]

H₂O(l) + H₂O(l) H₃O⁺(aq) + OH⁻(aq)

In pure water the majority of molecules are H₂O, but the molecules are constantly dissociating and re-associating, and at any time a small number of the molecules (always near 1 in 10⁷) are hydronium and an equal number are hydroxide. Because the numbers are equal, pure water is neutral (not acidic or basic).

An Arrhenius base, on the other hand, is a substance which increases the concentration of hydroxide ions when dissolved in water, hence decreasing the concentration of hydronium.

The constant association and disassociation of H₂O molecules forms an equilibrium in which any increase in the concentration of hydronium is accompanied by a decrease in the concentration of hydroxide, thus an Arrhenius acid could also be said to be one that decreases hydroxide concentration, with an Arrhenius base increasing it.

The reason that pHs of acids are less than 7 is that the concentration of hydronium ions is greater than 10⁻⁷ moles per liter. Since pH is defined as the negative logarithm of the concentration of hydronium ions, acids thus have pHs of less than 7.

Brønsted-Lowry acids[edit]

Main article: Brønsted–Lowry acid–base theory

Acetic acid, a weak acid, donates a proton (hydrogen ion, highlighted in green) to water in an equilibrium reaction to give the acetate ion and the hydronium ion. Red: oxygen, black: carbon, white: hydrogen.

While the Arrhenius concept is useful for describing many reactions, it is also quite limited in its scope. In 1923 chemists Johannes Nicolaus Brønsted and Thomas Martin Lowry independently recognized that acid-base reactions involve the transfer of a proton. A Brønsted-Lowry acid (or simply Brønsted acid) is a species that donates a proton to a Brønsted-Lowry base.^[2] Brønsted-Lowry acid-base theory has several advantages over Arrhenius theory. Consider the following reactions of acetic acid (CH₃COOH), the organic acid that gives vinegar its characteristic taste:

CH
3COOH + H
2O CH
3COO−
+ H
3O+

CH
3COOH + NH
3 CH
3COO−
+ NH+
4

Both theories easily describe the first reaction: CH₃COOH acts as an Arrhenius acid because it acts as a source of H₃O⁺ when dissolved in water, and it acts as a Brønsted acid by donating a proton to water. In the second example CH₃COOH undergoes the same transformation, in this case donating a proton to ammonia (NH₃), but cannot be described using the Arrhenius definition of an acid because the reaction does not produce hydronium.

Brønsted-Lowry theory can also be used to describe molecular compounds, whereas Arrhenius acids must be ionic compounds. Hydrogen chloride (HCl) and ammonia combine under several different conditions to form ammonium chloride, NH₄Cl. In aqueous solution HCl behaves as hydrochloric acid and exists as hydronium and chloride ions. The following reactions illustrate the limitations of Arrhenius's definition:

H₃O⁺(aq) + Cl⁻(aq) + NH₃ → Cl⁻(aq) + NH₄⁺(aq) + H₂O
HCl(benzene) + NH₃(benzene) → NH₄Cl(s)
HCl(g) + NH₃(g) → NH₄Cl(s)

As with the acetic acid reactions, both definitions work for the first example, where water is the solvent and hydronium ion is formed by the HCl solute. The next two reactions do not involve the formation of ions but are still proton transfer reactions. In the second reaction hydrogen chloride and ammonia (dissolved in benzene) react to form solid ammonium chloride in a benzene solvent and in the third gaseous HCl and NH₃ combine to form the solid.

Lewis acids[edit]

A third concept was proposed in 1923 by Gilbert N. Lewis which includes reactions with acid-base characteristics that do not involve a proton transfer. A Lewis acid is a species that accepts a pair of electrons from another species; in other words, it is an electron pair acceptor.^[2] Brønsted acid-base reactions are proton transfer reactions while Lewis acid-base reactions are electron pair transfers. All Brønsted acids are also Lewis acids, but not all Lewis acids are Brønsted acids. Contrast the following reactions which could be described in terms of acid-base chemistry.

In the first reaction a fluoride ion, F⁻, gives up an electron pair to boron trifluoride to form the product tetrafluoroborate. Fluoride "loses" a pair of valence electrons because the electrons shared in the B—F bond are located in the region of space between the two atomic nuclei and are therefore more distant from the fluoride nucleus than they are in the lone fluoride ion. BF₃ is a Lewis acid because it accepts the electron pair from fluoride. This reaction cannot be described in terms of Brønsted theory because there is no proton transfer. The second reaction can be described using either theory. A proton is transferred from an unspecified Brønsted acid to ammonia, a Brønsted base; alternatively, ammonia acts as a Lewis base and transfers a lone pair of electrons to form a bond with a hydrogen ion. The species that gains the electron pair is the Lewis acid; for example, the oxygen atom in H₃O⁺ gains a pair of electrons when one of the H—O bonds is broken and the electrons shared in the bond become localized on oxygen. Depending on the context, a Lewis acid may also be described as an oxidizer or an electrophile.

Dissociation and equilibrium[edit]

Reactions of acids are often generalized in the form HA H⁺ + A⁻, where HA represents the acid and A⁻ is the conjugate base. Acid-base conjugate pairs differ by one proton, and can be interconverted by the addition or removal of a proton (protonation and deprotonation, respectively). Note that the acid can be the charged species and the conjugate base can be neutral in which case the generalized reaction scheme could be written as HA⁺ H⁺ + A. In solution there exists an equilibrium between the acid and its conjugate base. The equilibrium constant K is an expression of the equilibrium concentrations of the molecules or the ions in solution. Brackets indicate concentration, such that [H₂O] means the concentration of H₂O. The acid dissociation constant K_a is generally used in the context of acid-base reactions. The numerical value of K_a is equal to the concentration of the products divided by the concentration of the reactants, where the reactant is the acid (HA) and the products are the conjugate base and H⁺.

The stronger of two acids will have a higher K_a than the weaker acid; the ratio of hydrogen ions to acid will be higher for the stronger acid as the stronger acid has a greater tendency to lose its proton. Because the range of possible values for K_a spans many orders of magnitude, a more manageable constant, pK_a is more frequently used, where pK_a = -log₁₀ K_a. Stronger acids have a smaller pK_a than weaker acids. Experimentally determined pK_a at 25 °C in aqueous solution are often quoted in textbooks and reference material.

Nomenclature[edit]

In the classical naming system, acids are named according to their anions. That ionic suffix is dropped and replaced with a new suffix (and sometimes prefix), according to the table below. For example, HCl has chloride as its anion, so the -ide suffix makes it take the form hydrochloric acid. In the IUPAC naming system, "aqueous" is simply added to the name of the ionic compound. Thus, for hydrogen chloride, the IUPAC name would be aqueous hydrogen chloride. The prefix "hydro-" is added only if the acid is made up of just hydrogen and one other element.

Classical naming system:

Anion prefix	Anion suffix	Acid prefix	Acid suffix	Example
per	ate	per	ic acid	perchloric acid (HClO₄)
	ate		ic acid	chloric acid (HClO₃)
	ite		ous acid	chlorous acid (HClO₂)
hypo	ite	hypo	ous acid	hypochlorous acid (HClO)
	ide	hydro	ic acid	hydrochloric acid (HCl)

Acid strength[edit]

Main article: Acid strength

The strength of an acid refers to its ability or tendency to lose a proton. A strong acid is one that completely dissociates in water; in other words, one mole of a strong acid HA dissolves in water yielding one mole of H⁺ and one mole of the conjugate base, A⁻, and none of the protonated acid HA. In contrast a weak acid only partially dissociates and at equilibrium both the acid and the conjugate base are in solution. Examples of strong acids are hydrochloric acid (HCl), hydroiodic acid (HI), hydrobromic acid (HBr), perchloric acid (HClO₄), nitric acid (HNO₃) and sulfuric acid (H₂SO₄). In water each of these essentially ionizes 100%. The stronger an acid is, the more easily it loses a proton, H⁺. Two key factors that contribute to the ease of deprotonation are the polarity of the H—A bond and the size of atom A, which determines the strength of the H—A bond. Acid strengths are also often discussed in terms of the stability of the conjugate base.

Stronger acids have a larger K_a and a more negative pK_a than weaker acids.

Sulfonic acids, which are organic oxyacids, are a class of strong acids. A common example is toluenesulfonic acid (tosylic acid). Unlike sulfuric acid itself, sulfonic acids can be solids. In fact, polystyrene functionalized into polystyrene sulfonate is a solid strongly acidic plastic that is filterable.

Superacids are acids stronger than 100% sulfuric acid. Examples of superacids are fluoroantimonic acid, magic acid and perchloric acid. Superacids can permanently protonate water to give ionic, crystalline hydronium "salts". They can also quantitatively stabilize carbocations.

While K_a measures the strength of an acid compound, the strength of an aqueous acid solution is measured by pH, which is an indication of the concentration of hydronium in the solution. The pH of a simple solution of an acid compound in water is determined by the dilution of the compound and the compound's K_a.

Chemical characteristics[edit]

Monoprotic acids[edit]

Monoprotic acids are those acids that are able to donate one proton per molecule during the process of dissociation (sometimes called ionization) as shown below (symbolized by HA):

HA(aq) + H₂O(l) H₃O⁺(aq) + A⁻(aq) K_a

Common examples of monoprotic acids in mineral acids include hydrochloric acid (HCl) and nitric acid (HNO₃). On the other hand, for organic acids the term mainly indicates the presence of one carboxylic acid group and sometimes these acids are known as monocarboxylic acid. Examples in organic acids include formic acid (HCOOH), acetic acid (CH₃COOH) and benzoic acid (C₆H₅COOH).

See also: Acid dissociation constant#Monoprotic acids

Polyprotic acids[edit]

Polyprotic acids, also known as polybasic acids, are able to donate more than one proton per acid molecule, in contrast to monoprotic acids that only donate one proton per molecule. Specific types of polyprotic acids have more specific names, such as diprotic acid (two potential protons to donate) and triprotic acid (three potential protons to donate).

A diprotic acid (here symbolized by H₂A) can undergo one or two dissociations depending on the pH. Each dissociation has its own dissociation constant, K_a1 and K_a2.

H₂A(aq) + H₂O(l) H₃O⁺(aq) + HA⁻(aq) K_a1

HA⁻(aq) + H₂O(l) H₃O⁺(aq) + A²⁻(aq) K_a2

The first dissociation constant is typically greater than the second; i.e., K_a1 > K_a2. For example, sulfuric acid (H₂SO₄) can donate one proton to form the bisulfate anion (HSO₄⁻), for which K_a1 is very large; then it can donate a second proton to form the sulfate anion (SO₄^2-), wherein the K_a2 is intermediate strength. The large K_a1 for the first dissociation makes sulfuric a strong acid. In a similar manner, the weak unstable carbonic acid (H₂CO₃) can lose one proton to form bicarbonate anion (HCO₃⁻) and lose a second to form carbonate anion (CO₃^2-). Both K_a values are small, but K_a1 > K_a2 .

A triprotic acid (H₃A) can undergo one, two, or three dissociations and has three dissociation constants, where K_a1 > K_a2 > K_a3.

H₃A(aq) + H₂O(l) H₃O⁺(aq) + H₂A⁻(aq) K_a1

H₂A⁻(aq) + H₂O(l) H₃O⁺(aq) + HA²⁻(aq) K_a2

HA²⁻(aq) + H₂O(l) H₃O⁺(aq) + A³⁻(aq) K_a3

An inorganic example of a triprotic acid is orthophosphoric acid (H₃PO₄), usually just called phosphoric acid. All three protons can be successively lost to yield H₂PO₄⁻, then HPO₄^2-, and finally PO₄^3-, the orthophosphate ion, usually just called phosphate. An organic example of a triprotic acid is citric acid, which can successively lose three protons to finally form the citrate ion. Even though the positions of the protons on the original molecule may be equivalent, the successive K_a values will differ since it is energetically less favorable to lose a proton if the conjugate base is more negatively charged.

Although the subsequent loss of each hydrogen ion is less favorable, all of the conjugate bases are present in solution. The fractional concentration, α (alpha), for each species can be calculated. For example, a generic diprotic acid will generate 3 species in solution: H₂A, HA^-, and A^2-. The fractional concentrations can be calculated as below when given either the pH (which can be converted to the [H⁺]) or the concentrations of the acid with all its conjugate bases:

$\alpha_{H_2 A}={{[H^+]^2} \over {[H^+]^2 + [H^+]K_1 + K_1 K_2}}= {{[H_2 A]} \over {[H_2 A]+[HA^-]+[A^{2-} ]}}$

$\alpha_{HA^- }={{[H^+]K_1} \over {[H^+]^2 + [H^+]K_1 + K_1 K_2}}= {{[HA^-]} \over {[H_2 A]+[HA^-]+[A^{2-} ]}}$

$\alpha_{A^{2-}}={{K_1 K_2} \over {[H^+]^2 + [H^+]K_1 + K_1 K_2}}= {{[A^{2-} ]} \over {[H_2 A]+[HA^-]+[A^{2-} ]}}$

A plot of these fractional concentrations against pH, for given K₁ and K₂, is known as a Bjerrum plot.

A pattern is observed in the above equations and can be expanded to the general n -protic acid that has been deprotonated i -times:

$\alpha_{H_{n-i} A^{i-} }= {{[H^+ ]^{n-i} \displaystyle \prod_{j=0}^{i}K_j} \over { \displaystyle \sum_{i=0}^n \Big[ [H^+ ]^{n-i} \displaystyle \prod_{j=0}^{i}K_j} \Big] }$ where K₀ = 1 and the other K-terms are the dissociation constants for the acid.

See also: Acid dissociation constant#Polyprotic acids

Neutralization[edit]

Hydrochloric acid (in beaker) reacting with ammonia fumes to produce ammonium chloride (white smoke).

Neutralization is the reaction between an acid and a base, producing a salt and neutralized base; for example, hydrochloric acid and sodium hydroxide form sodium chloride and water:

HCl(aq) + NaOH(aq) → H₂O(l) + NaCl(aq)

Neutralization is the basis of titration, where a pH indicator shows equivalence point when the equivalent number of moles of a base have been added to an acid. It is often wrongly assumed that neutralization should result in a solution with pH 7.0, which is only the case with similar acid and base strengths during a reaction.

Neutralization with a base weaker than the acid results in a weakly acidic salt. An example is the weakly acidic ammonium chloride, which is produced from the strong acid hydrogen chloride and the weak base ammonia. Conversely, neutralizing a weak acid with a strong base gives a weakly basic salt, e.g. sodium fluoride from hydrogen fluoride and sodium hydroxide.

Weak acid–weak base equilibrium[edit]

Main article: Henderson–Hasselbalch equation

In order for a protonated acid to lose a proton, the pH of the system must rise above the pK_a of the acid. The decreased concentration of H⁺ in that basic solution shifts the equilibrium towards the conjugate base form (the deprotonated form of the acid). In lower-pH (more acidic) solutions, there is a high enough H⁺ concentration in the solution to cause the acid to remain in its protonated form.

Solutions of weak acids and salts of their conjugate bases form buffer solutions.

Applications of acids[edit]

There are numerous uses for acids. Acids are often used to remove rust and other corrosion from metals in a process known as pickling. They may be used as an electrolyte in a wet cell battery, such as sulfuric acid in a car battery.

Strong acids, sulfuric acid in particular, are widely used in mineral processing. For example, phosphate minerals react with sulfuric acid to produce phosphoric acid for the production of phosphate fertilizers, and zinc is produced by dissolving zinc oxide into sulfuric acid, purifying the solution and electrowinning.

In the chemical industry, acids react in neutralization reactions to produce salts. For example, nitric acid reacts with ammonia to produce ammonium nitrate, a fertilizer. Additionally, carboxylic acids can be esterified with alcohols, to produce esters.

Acids are used as additives to drinks and foods, as they alter their taste and serve as preservatives. Phosphoric acid, for example, is a component of cola drinks. Acetic acid is used in day to day life as vinegar. Carbonic acid is an important part of some cola drinks and soda. Citric acid is used as a preservative in sauces and pickles.

Tartaric acid is an important component of some commonly used foods like unripened mangoes and tamarind. Natural fruits and vegetables also contain acids. Citric acid is present in oranges, lemon and other citrus fruits. Oxalic acid is present in tomatoes, spinach, and especially in carambola and rhubarb; rhubarb leaves and unripe carambolas are toxic because of high concentrations of oxalic acid.

Ascorbic acid (Vitamin C) is an essential vitamin for the human body and is present in such foods as amla, lemon, citrus fruits, and guava.

Certain acids are used as drugs. Acetylsalicylic acid (Aspirin) is used as a pain killer and for bringing down fevers.

Acids play important roles in the human body. The hydrochloric acid present in the stomach aids in digestion by breaking down large and complex food molecules. Amino acids are required for synthesis of proteins required for growth and repair of body tissues. Fatty acids are also required for growth and repair of body tissues. Nucleic acids are important for the manufacturing of DNA and RNA and transmitting of traits to offspring through genes. Carbonic acid is important for maintenance of pH equilibrium in the body.

Acid catalysis[edit]

Main article: Acid catalysis

Acids are used as catalysts in industrial and organic chemistry; for example, sulfuric acid is used in very large quantities in the alkylation process to produce gasoline. Strong acids, such as sulfuric, phosphoric and hydrochloric acids also effect dehydration and condensation reactions. In biochemistry, many enzymes employ acid catalysis.^[3]

Biological occurrence[edit]

Basic structure of an amino acid.

Many biologically important molecules are acids. Nucleic acids, which contain acidic phosphate groups, include DNA and RNA. Nucleic acids contain the genetic code that determines many of an organism's characteristics, and is passed from parents to offspring. DNA contains the chemical blueprint for the synthesis of proteins which are made up of amino acid subunits. Cell membranes contain fatty acid esters such as phospholipids.

An α-amino acid has a central carbon (the α or alpha carbon) which is covalently bonded to a carboxyl group (thus they are carboxylic acids), an amino group, a hydrogen atom and a variable group. The variable group, also called the R group or side chain, determines the identity and many of the properties of a specific amino acid. In glycine, the simplest amino acid, the R group is a hydrogen atom, but in all other amino acids it is contains one or more carbon atoms bonded to hydrogens, and may contain other elements such as sulfur, oxygen or nitrogen. With the exception of glycine, naturally occurring amino acids are chiral and almost invariably occur in the L-configuration. Peptidoglycan, found in some bacterial cell walls contains some D-amino acids. At physiological pH, typically around 7, free amino acids exist in a charged form, where the acidic carboxyl group (-COOH) loses a proton (-COO⁻) and the basic amine group (-NH₂) gains a proton (-NH₃⁺). The entire molecule has a net neutral charge and is a zwitterion, with the exception of amino acids with basic or acidic side chains. Aspartic acid, for example, possesses one protonated amine and two deprotonated carboxyl groups, for a net charge of −1 at physiological pH.

Fatty acids and fatty acid derivatives are another group of carboxylic acids that play a significant role in biology. These contain long hydrocarbon chains and a carboxylic acid group on one end. The cell membrane of nearly all organisms is primarily made up of a phospholipid bilayer, a micelle of hydrophobic fatty acid esters with polar, hydrophilic phosphate "head" groups. Membranes contain additional components, some of which can participate in acid-base reactions.

In humans and many other animals, hydrochloric acid is a part of the gastric acid secreted within the stomach to help hydrolyze proteins and polysaccharides, as well as converting the inactive pro-enzyme, pepsinogen into the enzyme, pepsin. Some organisms produce acids for defense; for example, ants produce formic acid.

Acid-base equilibrium plays a critical role in regulating mammalian breathing. Oxygen gas (O₂) drives cellular respiration, the process by which animals release the chemical potential energy stored in food, producing carbon dioxide (CO₂) as a byproduct. Oxygen and carbon dioxide are exchanged in the lungs, and the body responds to changing energy demands by adjusting the rate of ventilation. For example, during periods of exertion the body rapidly breaks down stored carbohydrates and fat, releasing CO₂ into the blood stream. In aqueous solutions such as blood CO₂ exists in equilibrium with carbonic acid and bicarbonate ion.

CO₂ + H₂O H₂CO₃ H⁺ + HCO₃⁻

It is the decrease in pH that signals the brain to breathe faster and deeper, expelling the excess CO₂ and resupplying the cells with O₂.

Aspirin (acetylsalicylic acid) is a carboxylic acid.

Cell membranes are generally impermeable to charged or large, polar molecules because of the lipophilic fatty acyl chains comprising their interior. Many biologically important molecules, including a number of pharmaceutical agents, are organic weak acids which can cross the membrane in their protonated, uncharged form but not in their charged form (i.e. as the conjugate base). For this reason the activity of many drugs can be enhanced or inhibited by the use of antacids or acidic foods. The charged form, however, is often more soluble in blood and cytosol, both aqueous environments. When the extracellular environment is more acidic than the neutral pH within the cell, certain acids will exist in their neutral form and will be membrane soluble, allowing them to cross the phospholipid bilayer. Acids that lose a proton at the intracellular pH will exist in their soluble, charged form and are thus able to diffuse through the cytosol to their target. Ibuprofen, aspirin and penicillin are examples of drugs that are weak acids.

Common acids[edit]

Mineral acids (inorganic acids)[edit]

Hydrogen halides and their solutions: hydrofluoric acid (HF), hydrochloric acid (HCl), hydrobromic acid (HBr), hydroiodic acid (HI)
Halogen oxoacids: hypochlorous acid (HClO), chlorous acid (HClO₂), chloric acid (HClO₃), perchloric acid (HClO₄), and corresponding compounds for bromine and iodine
Sulfuric acid (H₂SO₄)
Fluorosulfuric acid (HSO₃F)
Nitric acid (HNO₃)
Phosphoric acid (H₃PO₄)
Fluoroantimonic acid (HSbF₆)
Fluoroboric acid (HBF₄)
Hexafluorophosphoric acid (HPF₆)
Chromic acid (H₂CrO₄)
Boric acid (H₃BO₃)

Sulfonic acids[edit]

Methanesulfonic acid (or mesylic acid, CH₃SO₃H)
Ethanesulfonic acid (or esylic acid, CH₃CH₂SO₃H)
Benzenesulfonic acid (or besylic acid, C₆H₅SO₃H)
p-Toluenesulfonic acid (or tosylic acid, CH₃C₆H₄SO₃H)
Trifluoromethanesulfonic acid (or triflic acid, CF₃SO₃H)
Polystyrene sulfonic acid (sulfonated polystyrene, [CH₂CH(C₆H₄)SO₃H]_n)

Carboxylic acids[edit]

Acetic acid (CH₃COOH)
Citric acid (C₆H₈O₇)
Formic acid (HCOOH)
Gluconic acid HOCH₂-(CHOH)₄-COOH
Lactic acid (CH₃-CHOH-COOH)
Oxalic acid (HOOC-COOH)
Tartaric acid (HOOC-CHOH-CHOH-COOH)

Halogenated carboxylic acids[edit]

Halogenation at alpha position increases acid strength, so that the following acids are all stronger than acetic acid.

Fluoroacetic acid
Trifluoroacetic acid
Chloroacetic acid
Dichloroacetic acid
Trichloroacetic acid

Vinylogous carboxylic acids[edit]

Normal carboxylic acids are the direct union of a carbonyl group and a hydroxy group. In vinylogous carboxylic acids, a carbon-carbon double bond separates the carbonyl and hydroxyl groups.

Ascorbic acid

Nucleic acids[edit]

Deoxyribonucleic acid (DNA)
Ribonucleic acid (RNA)

References[edit]

^ Merriam-Webster's Online Dictionary: acid
^ ^a ^b ^c Ebbing, D.D., & Gammon, S. D. (2005). General chemistry (8th ed.). Boston, MA: Houghton Mifflin. ISBN 0-618-51177-6
^ Voet, Judith G.; Voet, Donald (2004). Biochemistry. New York: J. Wiley & Sons. pp. 496–500. ISBN 978-0-471-19350-0.

Listing of strengths of common acids and bases
IUPAC Gold Book - acid
Zumdahl, Chemistry, 4th Edition.
Ebbing, D.D., & Gammon, S. D. (2005). General chemistry (8th ed.). Boston, MA: Houghton Mifflin. ISBN 0-618-51177-6
Pavia, D.L., Lampman, G.M., & Kriz, G.S. (2004). Organic chemistry volume 1: Organic chemistry 351. Mason, OH: Cenage Learning. ISBN 0-7593-4727-1

External links[edit]

Science Aid: Acids and Bases Information for High School students
Curtipot: Acid-Base equilibria diagrams, pH calculation and titration curves simulation and analysis – freeware
A summary of the Properties of Acids for the beginning chemistry student
The UN ECE Convention on Long-Range Transboundary Air Pollution
Chem 106 – Acidity Concepts

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2. Chapter 10A：酸と塩基 chapter 10a acids and bases
3. Traumatic hyphema: Management
4. What's new in palliative care
5. Hereditary spastic paraplegia

English Journal

A New Role for Myeloid HO-1 in the Innate to Adaptive Crosstalk and Immune Homeostasis.

Koliaraki V, Kollias G.SourceBiomedical Sciences Research Center "Al. Fleming", Institute of Immunology, Vari, 16672, Greece, kollias@fleming.gr.
Advances in experimental medicine and biology.Adv Exp Med Biol.2012;780:101-11.
Increasing evidence supports the presence of a dynamic crosstalk between innate and adaptive immunity with a pivotal role played by pathways governing innate immune responses. TLRs (Toll-like receptors) and RLHs (retinoic acid-inducible gene I [RIG-I]-like helicases) are known to play a key role in
PMID 21842368

Phytochemical characteristics, free radical scavenging activities, and neuroprotection of five medicinal plant extracts.

Chang CL, Lin CS, Lai GH.SourceResearch Institute of Biotechnology, HungKuang University, 34 Chung-Chie Rd, Sha Lu, Taichung 43302, Taiwan.
Evidence-based complementary and alternative medicine : eCAM.Evid Based Complement Alternat Med.2012;2012:984295. Epub 2011 Aug 10.
The objective of this study was to determine phytochemical characteristics, chemiluminescence antioxidant capacities, and neuroprotective effects on PC12 cells for methanol extracts of Spatholobus suberectus, Uncaria rhynchophylla, Alpinia officinarum, Drynaria fortunei, and Crataegus pinnatifida. T
PMID 21845204

Towards modernization of the formulation of the traditional uighur medicine herbal preparation abnormal savda munziq.

Kizaibek M, Popescu R, Prinz S, Upur H, Singhuber J, Zehl M, Kopp B.SourceFaculty of Traditional Uighur Medicine, Xinjiang Medical University, Urumqi 830011, China.
Evidence-based complementary and alternative medicine : eCAM.Evid Based Complement Alternat Med.2012;2012:863101. Epub 2011 Aug 7.
Abnormal Savda Munziq (ASMq) is a herbal preparation used in Traditional Uighur Medicine for the treatment and prevention of diabetes, cardiovascular diseases, chronic asthma and cancer. The recommended dose of this decoction for cancer patients is 500?mL administered orally three times a day. Our
PMID 21837249

Japanese Journal

Transport of DMAA and MMAA into rice (Oryza sativa L.) roots

Rahman M.A.,Kadohashi K.,Maki Teruya,Hasegawa Hiroshi
Environmental and Experimental Botany 72(1), 41-46, 2011-08
… Previous studies reported that the dimethylarsinic acid (DMAA) and monomethylarsonic acid (MMAA) uptake in duckweed (Spirodela polyrhiza L.) differed from that of As(V), and was unaffected by phosphate (H2PO4). …
NAID 120002086353

Influence of chelating ligands on bioavailability and mobility of iron in plant growth media and their effect on radish growth

Hasegawa Hiroshi,Rahman M.A.,Saitou K.,Kobayashi M.,Okumura C.
Environmental and Experimental Botany 71(3), 345-351, 2011-07
… Ethylenediaminedisuccinic acid (EDDS) and hydroxy-iminodisuccinic acid (HIDS) produced the highest apparent mobility of iron from the bottom layer of the medium (initially 10-4M Fe(III)) to the upper layer (no iron), followed by glutamatediacetic acid (GLDA), ethylenediaminetetraacetic acid (EDTA), methylglycinediacetic acid (MGDA), and iminodisuccinic acid (IDS). …
NAID 120002924873

ent-Eudesmane sesquiterpenoids, galloyl esters of the oak lactone precursor, and a 3-O-methylellagic acid glycoside from the wood of Platycarya strobilacea.

Maeda Hajime,Kakoki Narumi,Ayabe Mami,Koga Yuki,Oribe Tomoko,Matsuo Yosuke,Tanaka Takashi,Kouno Isao
Phytochemistry 72(8), 796-803, 2011-06
… In addition, two other compounds, the 6'-O-m- and p-digalloyl oak lactone precursor and the 3-O-methylellagic acid 4'-O-(4″-O-galloyl)-xylopyranoside, were isolated from the charred wood along with m- and p-digallic acid. …
NAID 120003001162

Related Pictures

★リンクテーブル★

リンク元	「100Cases 10」「100Cases 27」「100Cases 34」「100Cases 16」「酸」
拡張検索	「dicarboxylic acid transporter」「antacid」「tioctic acid」

「100Cases 10」

　　[★]

☆case10　背痛

■症例

27歳　女性

主訴：背中に突き抜ける？痛み(pain across her back)

現病歴：背中に広がる痛みを訴えて、27歳の女性が救急部に運ばれてきた。２日前に熱が出て背部痛が始まり、以降調子が悪い。痛みは増強している。6時間前に2度嘔吐した。

既往歴：3ヶ月前に合併症のない胆嚢炎。

・身体診断

調子が悪そうであり、紅潮している。体温：39.2℃。脈拍：120/分。血圧：104/68 mmHg。心血管系、呼吸器系に異常を認めず。腹部：全体的に圧痛。両側の腰部で著明な圧痛。

・検査

(血液生化学)

白血球↑、血清尿素↑、CRP↑

(尿検査)

タンパク：++、鮮血：+++、亜硝酸塩：++

尿の顕微鏡検査：(おそらく400倍の一視野に)赤血球>50、白血球>50

腹部X線：正常

■glossary

loin n. (pl)腰、腰部(→(adj.)lumbar)。(獣の)腰肉、ロイン。(pl)陰部、生殖器、性器

腸雑音、腸音、intestinal murmur、intestinal sound、bowel sound

urine microscopy 尿の顕微鏡検査

dysuria 排尿障害

urgency n. 切迫、急迫、危急。緊急、火急、焦眉の急。[pl]しつこい要求、懇願。せき立てる力、刺激

hydronephrosis 水腎症

-nephros 腎臓

-stomy 開口術

nephrostomy n. 腎瘻造設術、腎造瘻術、腎瘻術

obstructive urophathy 閉鎖性尿路疾患

intravenous fluid 静脈内輸液

commence vt. 始める、開始する。 vi. ～から始める、始まる(with)

urgently

eradication n. 根絶、撲滅

mimic vt. ～の物まねをする、まねて馬鹿にする。そっくりに[卑屈に]まねる。～によく似る

renal ultrasound 腎臓超音波検査

obstructive uropathy 閉塞性尿路疾患

polycystic kidney disease 多発性嚢胞腎

medullary sponge kidney 海綿腎

loin-pain hematuria syndrome 腰痛血尿症候群

■解説

(第1パラグラフ)疫学

　急性腎盂腎炎：男性より女性でmore common。尿路からの細菌の上行感染。リスク：妊娠、糖尿病、免疫低下者、尿路奇形(尿の腎臓への逆流。そして多分、狭窄していたりして結石で閉塞されやすいこともあると思う)

(第2パラグラフ)病態

　食欲不振、悪心、嘔吐と共に40℃の発熱が出ることがある。

　腎盂腎炎患者の中には膀胱炎の先行症状(排尿障害、頻尿、尿意切迫、血尿)がある人がいるけど、こういう下部尿路症状がいつも出現するわけではない。

　多くの腎盂腎炎患者は、先行する6ヶ月以内の膀胱炎の既往がある。

　老人の場合、非典型的な症状を示し、そして混乱した状態でやってくる。

　腎盂腎炎は他の病態によく似ている：急性虫垂炎、急性胆嚢炎、急性膵炎、下葉の肺炎

　普通、体表から見て腎臓の直上に前からも後ろからも圧痛を感じる。

　未治療の腎盂腎炎では敗血症になるかもしれない。

(第3パラグラフ)本ケースについて

　・CRP 上昇は急性感染症を示唆

　・顕微鏡的血尿・タンパク尿、白血球増多は尿路の炎症を示す。

　・硝酸塩(nitrate, HNO3と何かの塩)から亜硝酸塩(nitrite, HNO2と何かの塩)への還元により細菌の存在が確認される。

　　覚え方：亜硝酸は(Oが一つ)足らないi(愛)

　　でも複雑です。

　　　HNO2　亜硝酸 nitrous acid, nitrite　。亜硝酸塩 nitrite

　　　HNO3　硝酸 nitric acid, nitrate　　。硝酸塩 nitrate

(第4パラグラフ)管理

　・女性は入院すべき。

　・血液と尿の採取

　・静脈内輸液＋抗生物質で治療開始。微生物が同定されたら、感受性のある抗菌薬を使用する。初期治療ではゲンタマイシン、アンピシリン、シプロフロキサシンを用いる

　・腎臓エコー検査：尿路閉塞を除外するため。閉塞性尿路疾患では、激しい痛み、発熱、敗血症ショック、腎不全を伴う脳腎症を起こしうる。

　・尿路敗血症の経過で水腎症が疑われたら、合併症を防ぐために緊急に腎瘻を造設すべき

(第5パラグラフ)薬物治療

　・(腎結石など合併していない)腎感染症(ucomplicated renal infection)患者は抗生物質2週間のコースで治療すべき。

　・感染の根絶を確実にする治療が終わった後10-14日間は、反復して細菌培養をする。＜

　・尿路結石を有する感染症や腎瘢痕を有する患者では抗生物質6週間のコースが用いられる。

■鑑別診断のポイント

　腎盂腎炎は片側性、あるいは両側性の腰痛を引き起こす。

　腰部痛の鑑別診断：

　　閉塞性尿路疾患

　　腎梗塞：心疾患などで生じた血栓が腎動脈またはその分枝を閉塞し、その血管の支配領域が虚血性壊死に陥った状態。

　　腎細胞癌：腎尿細管上皮細胞より発生する悪性腫瘍

　　腎乳頭壊死：腎乳頭より腎髄質にかけて、その支配動脈の虚血により壊死を来したもの。主として基礎疾患に糖尿病を有する人にみられ、しばしば急性腎盂腎炎などの尿路感染に伴って発症する。

　　腎結石：

　　糸球体腎炎：

　　多発性嚢胞腎：先天性かつ両側性に腎実質内に大小無数の嚢胞を発生する。ほとんどが両側性で、貧血、顕微鏡的血尿、蛋白尿、高血圧といった症状を呈しながら腎機能が低下し、最終的には腎不全となる疾患

　　海綿腎：腎錐体における集合管の先天性嚢状拡張症。症状としては拡張した集合管に尿の停滞　→　感染・細かな結石ができる。

　　腰痛血尿症候群：若年女性に好発し、反復して出現する腰部から側腹部の強い疼痛と血尿を主徴とする病因不明の疾患。肉眼的血尿や軽度の蛋白尿がみられることもあるが、特異的な検査所見はなく、診断は他疾患の除外診断による

■KEYPOINT

・急性腎盂腎炎は下部尿路症状があったり無かったりする。

・腎臓超音波検査は尿路閉塞を否定するために、入院24時間後に行うべき。

・抗菌薬は、再発のリスクを最小限にするために、少なくとも2週間継続すべき。

□閉塞性尿路疾患(http://merckmanual.jp/mmpej/sec17/ch229/ch229a.htmlより引用)

閉塞性尿路疾患は正常な尿流を構造的または機能的に妨げ，ときに腎機能不全（閉塞性腎症）を起こすことがある。症状は，慢性の閉塞では認められないこともあるが，T11からT12にかけての皮膚分節に放散する疼痛，無尿，夜間頻尿または多尿がある。診断は閉塞のレベルによって，膀胱カテーテル法，超音波検査，CT，膀胱尿道鏡検査，膀胱尿道撮影または腎盂造影に基づく。治療は原因によって異なり，迅速なドレナージ，器具使用，外科手術（例，内視鏡法，砕石術）および/またはホルモン療法を必要とする場合がある。

□KUBの陰影から尿路結石成分の推定

　リン酸カルシウム(22.0)

　シュウ酸カルシウム(10.8)：シュウ酸カルシウム結石は，尿路結石のうちで最も頻度が高く（70～80％），シュウ酸カルシウム結石の約半数はリン酸カルシウムとの混合結石である。

　リン酸マグネシウムアンモニウム(4.1)：ストラバイト結石：尿素分解菌(Proteus　、Klebsiella　、Pseudomonas　)による尿路感染が原因で、尿素が分解されアンモニアとなると尿がアルカリ性となり、リン酸マグネシウムアンモニウム結石が形成される。

　シスチン(3.7)：ホモシスチン尿症

　尿酸(1.4)：痛風

　キサンチン(1.4)：プリン体

□多嚢胞腎

　常染色体劣性多発性嚢胞腎：ARPKD

　　旧名：幼児型嚢胞腎

　常染色体優性多発性嚢胞腎：ADPKD

　　旧名：成人型嚢胞腎

「100Cases 27」

　　[★]

☆case27　関節痛

■症例

37歳　女性

主訴：関節痛

現病歴：数ヶ月、膝の痛みがだんだん強くなっていると感じていた。痛みは手や足の小関節に多く、朝歩くときに最もこわばる。痛みはジクロフェナクを飲むと和らぐ。そのほかの症状として疲労感を感じ、最近、体重が３ヶ月で４ｋｇ減っている。

喫煙歴：なし。

飲酒歴：機会飲酒

既往歴：なし

家族歴：既婚、子供は２人

服薬歴：ジクロフェナク

職業歴：legal sevretary

身体所見 examination

　顔貌　青白、臨床的な貧血を認める。近位指節間関節・中手指節関節　腫脹・effusionを伴う疼痛。中足趾節関節　圧痛。それ以外は正常。

検査　 investigation

　血液検査

　　Hb低下

　　ESR 上昇

　　尿素軽度上昇

　　クレアチニン軽度上昇

　　正常：白血球、MCV、血小板、ナトリウム、カリウム、グルコース、アルブミン

　尿検査

　　蛋白(-)、尿糖(-)、潜血(-)、

■問題

　本症例では診断とその根拠を考えるのは簡単なので、鑑別疾患をあげてその疾患に特徴的な症候を列挙しましょう。

■関節痛 DIF.283

　V Vascular

　　血友病 hemophilia　血友病性関節症(急性：疼痛、腫脹、熱感(SOR.241)

慢性：可動域の低下、変形、関節周囲筋萎縮(SOR.241))。家族歴

　　壊血病 scurvy　。生活環境。食事歴

　　無菌性骨壊死 aseptic bone necrosis (Osgood-Schlatter diseaseとか)

　I Inflammatory

　　感染性関節炎(細菌性関節炎(化膿性関節炎・淋菌性関節炎・結核性関節炎・嫌気性菌関節炎 )、真菌性関節炎、スピロヘータ関節炎(梅毒性関節炎・ライム関節炎)、マイコプラズマ関節炎、ウイルス性関節炎)

　N Neoplastic disorders

　　骨原性肉腫 osteogenic sarcoma

　　巨細胞腫 giant cell tumors

　D Degenerative disorders

　　degenerative joint disease

　　変形性関節症 osteoarthritis

　I Intoxication

　　痛風 gout (uric acid)

　　偽痛風 pseudogout (calcium pyrophosphate)

　　ループス症候群 lupus syndrome of hydralazine (Apresoline) and procainamide

　　gout syndrome of diuretics

　C Congenital and acquired malformations bring to mind the joint deformities of tabes dorsalis and syringomyelia and congenital dislocation of the hip. Alkaptonuria is also considered here.

　A Autoimmune indicates

　　関節リウマチ RA

　　血清病 serum sickness

　　全身性エリテマトーデス lupus erythematosus

　　リウマチ熱 rheumatic fever

　　ライター症候群 Reiter syndrome

　　潰瘍性大腸炎 ulcerative colitis

　　クローン病=限局性回腸炎 regional ileitis

　　乾癬性関節炎 psoriatic arthritis

　　リウマチ性多発筋痛症 polymyalgia rheumatica

　T Trauma

　E Endcrine

　　先端肥大症 acromegaly

　　閉経 menopause

　　糖尿病 diabetes mellitus

■関節炎の分類

・炎症部位の数

　単関節炎：痛風、偽痛風、離断性骨軟骨炎、血行性の化膿性関節炎のほとんど

　多関節炎：リウマチ性疾患、ウイルス性疾患、白血病での関節症状、易感染性宿主における血行性の化膿性関節炎

■関節リウマチ

　診断基準

　関節症状

　　朝のこわばり、疼痛、腫脹、関節の動揺、関節可動域制限、変形(手指、足趾、膝関節)。(SOR.211)

　　手指の近位指節間関節(PIP 関節)、中手指節関節(MP 関節)。遠位指節間関節(DIP 関節)に初発することは稀。(SOR.211)

　　左右対称性に生じることが多い。手関節、足趾、膝関節に初発する。(SOR.211)

　関節外症状

　　全身症状：発熱

　　皮膚症状：リウマトイド結節(肘の伸側、後頭部、手指)

　　眼症状：上胸膜炎(10日の経過で治癒)、強膜炎(予後不良)。稀に角膜穿孔

　　血液障害：(高頻度)貧血、白血球減少(Felty病。DMARDs投与中の場合は薬剤性の骨髄抑制を考慮)

　　アミロイドーシス：ネフローゼや下痢を来した症例で疑う。アミロイド蛋白はAA

　　腎障害：稀。アミロイドーシスの続発症か薬剤性を考慮。

　　呼吸器症状：間質性肺炎の合併多い。下肺野に好発。通常無症状。メトトレキセートなどの使用により薬剤性の急性間質性肺炎を生じることがある。

　　心・血管障害：リンパ管炎による難治性の浮腫。

　　神経症状：環軸関節亜脱臼により項部痛や脊髄症上が出現しうる。

　　骨粗鬆症

　　腱鞘滑膜炎：手指、手関節、足関節

■両側性多関節炎の鑑別疾患

　OA：遠位指節間関節を冒すのが特徴的で、近位指節間関節、中手指節関節を冒しうる。

　RA：

　SLE：軽度、症状の程度が変動する非びらん性の関節炎

　gout：単関節炎からはじまる。

　血清陰性関節炎：強直性脊椎炎、感染、ライター病：中～大関節に非対称性の関節炎。仙腸関節と遠位指節間関節にも関節炎

　急性ウイルス性関節炎：風疹。

■KEY POINTS

・RAでは遠位指節間関節は冒されない傾向がある。

・RAの全身症状は関節症状に先行することがある。

・RAの活動性と貧血及びESRは相関している。

・NSAIDsは腎機能に悪影響を与えることがある。

■initial plan

　Dx 1. 単純X線写真

　　　　・亜脱臼、関節周囲の骨萎縮(傍関節性骨骨粗鬆症,juxta-articular osteoporosis)、関節裂隙の狭小化、関節辺縁のびらん(bony erosion)

　　　　　・初期のRAで第5趾に骨びらんが一般的に見られる。

　　　　・血液検査

　　　　　・RF、抗DNA 抗体

　Tx 1. 鎮痛薬

　　　　・NSAIDs：鎮痛とこわばりの軽減

　　 2. DMARDs(メトトレキセート、レフルノミド、金製剤、ペニシラミン)

　　　　・NSAIDsで症状が治まらない場合に考慮

　　 3. 抗TNF 抗体

　　　　・重症のRAで効果がある場合がある。

■参考文献

SOR　標準整形外科学第10版医学書院

DIF　Differential Diagnosis in Primary Care Fourth Edition版 Lippincott Williams & Wilkins

「100Cases 34」

　　[★]

☆case34　てんかん発作

■症例

23歳　アフリカ-カリブ系　女性　銀行の店員

主訴：てんかん発作

現病歴：強直間代発作を2回起こしたところを母親が目撃していた。娘の行動は次第におかしくなり、また娘は自分のことを話している声が聞こえていた(幻聴)。最近、頭痛を訴えていた。体重が減少し、脱毛があった。盗汗と主に足と手の小関節に及ぶflitting 関節痛を訴えていた。服用薬なし。タバコ1日5-10本、アルコール10 unit/week(缶ビール(350ml)6本弱)

既往歴：特記なし(medical or psychiatric history)

家族歴：

生活歴：

・身体診断

意識：眠そうだが痛みに反応。頚部硬直：なし。頭髪：薄く斑状。体温38.5℃。リンパ節：たくさんの部位で触知。

心拍：104/分、整。血圧：164/102 mmHg。心血管系、呼吸器系、腹部：異常なし。

神経所見：focal anormalityなし(局所性異常)。乳頭浮腫：認めず。

・検査

(血液生化学)

上昇：erythrocyte sedimentation rate、urea、creatinine

低下：hemoglobin、white cell count、platelet

正常：mean corpuscular volume、sodium、potassium、glucose

(腰椎穿刺)

上昇：leukocytes、CSF protein

正常：CSF glucose

(尿検査)

蛋白：＋＋＋。血尿：＋＋＋。赤血球：＋＋。赤血球円柱：あり。

(その他)

胸部X線：異常なし。ECG：洞性頻脈。頭部 CT：正常。CSF グラム染色：陰性(光顕レベルで細菌なし)

■glossary

fall out　(毛髪などが)抜ける

night sweat 盗汗、寝汗

tonic-clonic generalized seizure 全般性強直間代発作

flit　vi (鳥・蝶など)すいすい/ひらひら飛ぶ、飛び回る、飛翔する。(人が)軽やかに通る、行き交う。(時が)(飛ぶように)すぎる。(幻想など)去来する、よぎる、(表情が)かすめる

drowsy　adj. 眠い。眠そうな。眠気を誘う。ものうい。眠ったような

stiffness　n. 堅いこと、堅ぐるしさ、がんこさ

delirium tremens 振戦譫妄

hypertensive encephalopathy 高血圧性脳症

alopecia　脱毛症

African-Caribbean アフリカ-カリブ系

fit n.　(病気の)発作。引きつけ、痙攣。(感情の)激発、一時的興奮、気まぐれ

chorea n. 舞踏病

recreational drug 耽溺性があり乱用される脱法薬物

urgent adj. (物・事が)急を要する、緊急の、背拍質(pressing)。(～を)緊急に必要とする(in)。(S is ～ (with O1) for [in] O2)(人が)(O1(人)に)O2(物・事)をしつこく求める。(人に/～するように)催促する(for/to do)。(要求などが)執拗な。

□てんかん発作

・新規発生したてんかん発作の原因(ICU.805-806)

・薬物中毒(テオフィリンなど)

・薬物からの離脱(アルコールなど)

・感染症(髄膜炎、膿瘍など)

・頭部外傷

・虚血障害(虚血あるいはびまん性)

・占拠性病変(腫瘍あるいは血腫)

・代謝性障害(肝性脳症、尿毒症性脳症、敗血症、低血糖、低ナトリウム血症、低カルシウム血症など)

・合併症(ICU.805-806)

・全身性てんかん発作の場合：高血圧、乳酸アシドーシス、高体温、呼吸障害、誤嚥、肺水腫、横紋筋融解、自傷、不可逆性の神経学的障害(30分間以上てんかん発作が持続した場合)

■可能性の高い診断

　全身性エリテマトーデス systemic lupus erythematosus(SLE)

■鑑別診断のポイント

　自己免疫疾患は多彩な症状を示す。そのため、個々の症状に着目して鑑別診断をあげるのではなく、症状や検査値の異常を総合的に見て判断する必要がある。

■解答

　(第1パラグラフ)SLEの病態

精神症状：(SLEは脳で血管炎を呈することで生じる)うつ(depression)、統合失調症様の精神病、痙攣(fits)、舞踏病(chorea)、脳梗塞/脊髄梗塞

脳脊髄液：白血球増多(leukopenia)、蛋白増加

血液：自己免疫性溶血貧血(Coombs'-positive hemolytic anemia)がありうる。白血球減少と血小板減少症は普通にみられる。

腎症状：ループス腎炎は普通に見られ、顕微鏡的血尿・タンパク尿、ネフローゼ、あるいは腎不全が現れるかもしれない。

関節症状：変形を伴わない関節痛(PIP 関節(近位指節間関節)、MP 関節(中手指節関節)、手関節)

　(第2パラグラフ)SLEの確定診断のための検査・治療

　・すぐにすべきことは降圧薬、抗痙攣薬の投与

　・確定診断のために次の検査を行っていく(もっとも、症例の提示された所見で(日本の？)SLEの診断基準を満たすけど)

　　・検疫血清検査：抗DNA 抗体、C3、C4

　　・腎生検：ループス腎炎の程度を把握

　・治療：活動性の感染がないことを確認　←　薬物療法ではステロイドや免疫抑制薬を使うため

　　・ステロイド静脈内投与、あるいはシクロホスファミドなどの細胞毒性薬(cytotoxic agents)の投与

　　・重症、治療抵抗性だったら血漿交換を行う。

■鑑別診断　頭痛/精神病的様態(psychiatric features)/痙攣

・髄膜炎、脳炎

・レクリエーショナルドラッグの中毒(例えばコカイン)

・脳腫瘍

・急性のアルコール禁断症状：振戦譫妄

・高血圧脳症

■KEYPOINT

・SLEは特に若いアフリカ系-カリブ系に普通に一般的

・SLEでは主に神経症状と精神症状をを伴って現れることがある

・白血球低下と血小板の低下はしばしばSLEを示唆する

□tonic-clonic seizure 強直間代発作

　意識消失とともに全身の随意筋に強直痙攣が生じ(強直痙攣期tonic convulsion)、次いで全身の筋の強直と弛緩とが律動的に繰り返される時期(間代痙攣期clonic convulsion)を経て、発作後もうろう状態を呈する一連の発作。

□350ml アルコール5%

350x0.05/10=1.75 unit

□細胞毒性薬

　免疫抑制薬や抗腫瘍薬として用いられる。

antimetabolites

アザチオプリン azathioprine

メトトレキセート methotrexate

ミコフェノール酸 mycophenolic acid, ミコフェノール酸モフェチル mycophenolate mofetil

レフルノミド leflunomide

alkylating agents

シクロホスファミド cyclophosphamide

「100Cases 16」

　　[★]

☆case16　膝の痛み

■glossary

indigestion 消化障害、消化不良

■症例

80歳　男性

主訴：左膝の痛みと腫脹

現病歴：左膝の痛みを2日前から認めた。膝は発熱・腫脹しており、動かすと疼痛を生じる。時々胸焼けと消化不良が見られる。6ヶ月前のhealth checkで、高血圧(172/102mmHg)と血中クレアチニンが高い(正常高値)こと以外は正常といわれた。その4週間数回血圧を測定したが、高値が継続したため、2.5mg bendrofluamethizide(UK)/ベンドロフルメチアジド bendroflumethiazide(US)で治療を開始した。最近の血圧は138/84 mmHgであった。

喫煙歴：なし。

飲酒歴：一週間に平均4unit。

既往歴：股関節に中程度(mild)の変形性関節症

家族歴：特記なし

服薬歴：アセトアミノフェン(股関節の疼痛に対して)

身体所見 examination

　血圧 142/86mmHg。体温37.5℃。脈拍88/分。grade 2 hypertensive retinopathy(高血圧症性網膜症)。心血管系、呼吸器系に検査場異常なし。手にDIPにヘバーデン結節なし。

　左膝が発熱し腫脹している。関節内に液、patellar tap陽性。90℃以上膝関節を屈曲させると痛みを生じる。右の膝関節は正常に見える。

検査　 investigation

　生化学：白血球増多、ESR 上昇、尿素高値、グルコース高値

　単純X線：関節間隙やや狭小。それ以外に異常は認めない。

■problem list

　#1 左膝の痛み

　#2 胸焼け

　#3 消化不良

　#4 高血圧

　#5 クレアチニン正常高値

　#6 股関節の変形性リウマチ

　#7 高血圧性網膜症

■考え方

　・関節痛の鑑別診断を考える。

　・VINDICATEで考えてみてもよいでしょう。

　・関節痛の頻度としては　外傷＞慢性疾患(OAなど)＞膠原病＞脊椎疾患＞悪性腫瘍

■関節痛の鑑別疾患

DIF 282

V Vascular 血友病 hemophilia, 壊血病 scurvy, 無菌性骨壊死 aseptic bone necrosis (Osgood-Schlatter diseaseとか)

I Inflammatory 淋疾 gonorrhea, ライム病 lyme disease, 黄色ブドウ球菌 Staphylococcus, 連鎖球菌 Streptococcus, 結核 tuberculosis, 梅毒 syphilis, 風疹 rubella, 単純ヘルペス herpes simplex, HIV human immunodeficiency virus, サイトメガロウイルス cytomegalovirus

N Neoplastic disorders 骨原性肉腫 osteogenic sarcoma, 巨細胞腫 giant cell tumors

D Degenerative disorders degenerative joint disease or 変形性関節症 osteoarthritis

I Intoxication 痛風 gout (uric acid), 偽痛風 pseudogout (calcium pyrophosphate), ループス症候群 lupus syndrome of hydralazine (Apresoline) and procainamide, gout syndrome of diuretics

C Congenital and acquired malformations bring to mind the joint deformities of tabes dorsalis and syringomyelia and congenital dislocation of the hip. Alkaptonuria is also considered here.