scholarly journals The Dose Makes the Poison: A Case Report of Acquired Methemoglobinemia

2020 ◽  
Vol 17 (6) ◽  
pp. 1845
Author(s):  
Giulia Cannata ◽  
Luciana Abate ◽  
Chiara Scarabello ◽  
Monica Rubini ◽  
Alessandra Giacometti ◽  
...  
Keyword(s):  
Case Report ◽  
Oxygen Saturation ◽  
Partial Pressure ◽  
Venous Blood ◽  
Nasal Cannula ◽  
Partial Pressure Of Oxygen ◽  
Blood Oxygen Saturation ◽  
Peripheral Oxygen Saturation ◽  
Methemoglobin Level ◽  
Arterial Blood

Background: Methemoglobinemia (MET) should be suspected in cases where cyanosis is not associated with signs and symptoms of lung and/or heart disease, or in a cyanotic child exhibiting discrepancies in the partial pressure of oxygen in the arterial blood, the blood oxygen saturation, and the clinical assessment. Case presentation: A 10-month-old girl was taken to the Pediatric Emergency Department for the acute, sudden development of significant peroral cyanosis associated with gray pigmentation of the skin. The problem was evidenced approximately one hour after she ingested a homemade puree of mixed vegetables, mainly composed of potatoes and chards that had been prepared three days before and had been kept in the refrigerator since then. Physical examination revealed that the child was very pale, conscious, and without respiratory distress. Oxygen saturation of hemoglobin in the arterial blood (SpO2) was 94%. Respiratory, cardiovascular, and abdominal evaluations did not reveal any signs of disease. A venous blood sample showed chocolate-colored blood with a pH of 7.404, a partial pressure of CO2 (pCO2) of 40.6 mmHg, a partial pressure of oxygen (pO2) of 21.3 mmHg, a bicarbonate level of 24 mmol/L, and an oxygen saturation (SO2%) of 47.7%. CO-oximetry carried out simultaneously identified a methemoglobin level of 22%. MET was suspected, and oxygen via nasal cannula at a rate of 4 L/min was given with only a slight increase in oxygen saturation (96%). Slow intravenous injection of methylene blue 1 mg/kg over a period of 5 min was initiated. The peripheral oxygen saturation (SpO2) gradually improved to 100% over the next 20 min. Forty minutes later, venous blood gas analysis showed a methemoglobin level of 0.9% with a complete resolution of cyanosis; supplemental oxygen via nasal cannula was therefore discontinued. During the next 36 h, the patient remained hemodynamically stable with good oxygenation on room air. Conclusions: This case report shows that recognition of acquired MET in a child with sudden cyanosis onset requires a high index of suspicion. In daily activities, there is a need to pay particular attention when homemade vegetable soups for child alimentation are prepared. The consumption of vegetable soups must occur immediately after preparation. Storage in a refrigerator must last no more than 24 h and if longer storage is needed, vegetable soups should be frozen.

scholarly journals Monocrotaline pyrrole induces pulmonary endothelial damage through binding to and release from erythrocytes in lung during venous blood reoxygenation

2019 ◽  
Vol 316 (5) ◽  
pp. L798-L809 ◽  
Author(s):  
Rui Xiao ◽  
Liping Zhu ◽  
Yuan Su ◽  
Jiwei Zhang ◽  
Yankai Lu ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Pulmonary Hypertension ◽  
Partial Pressure ◽  
Venous Blood ◽  
Endothelial Damage ◽  
Toxic Metabolite ◽  
Partial Pressure Of Oxygen ◽  
Standard Dosage ◽  
Arterial Blood ◽  
Monocrotaline Pyrrole

Monocrotaline has been widely used to establish an animal model of pulmonary hypertension, most frequently in rats. An important feature of this model resides in the selectivity of monocrotaline injury toward the pulmonary vascular endothelium versus the systemic vasculature when administrated at standard dosage. The toxic metabolite of monocrotaline, monocrotaline pyrrole, is transported by erythrocytes. This study aimed to reveal whether partial pressure of oxygen of blood determined the binding and release of monocrotaline pyrrole from erythrocytes in rats with one subcutaneous injection of monocrotatline at the standard dosage of 60 mg/kg. Our experiments demonstrated that monocrotaline pyrrole bound to and released from erythrocytes at the physiological levels of partial pressure of oxygen in venous and arterial blood, respectively, and then aggregated on pulmonary artery endothelial cells. Monocrotaline pyrrole-induced damage of endothelial cells was also dependent on partial pressure of oxygen. In conclusion, our results demonstrate the importance of oxygen partial pressure on monocrotaline pyrrole binding to erythrocytes and on aggregation and injury of pulmonary endothelial cells. We suggest that these mechanisms contribute to pulmonary selectivity of this toxic injury model of pulmonary hypertension.

Atrial fibrillation associated with carbon monoxide poisoning

2019 ◽  
pp. 203-206
Author(s):  
Mevlut Demir ◽  
◽  
Muslum Sahin ◽  
Ahmet Korkmaz ◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Carbon Monoxide ◽  
Sinus Rhythm ◽  
Partial Pressure ◽  
Motor Vehicle ◽  
Carbon Monoxide Poisoning ◽  
Venous Blood ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood

Carbon monoxide intoxication occurs usually via inhalation of carbon monoxide that is emitted as a result of a fire, furnace, space heater, generator, motor vehicle. A 37-year-old male patient was admitted to the emergency department at about 5:00 a.m., with complaints of nausea, vomiting and headache. He was accompanied by his wife and children. His venous blood gas measures were: pH was 7.29, partial pressure of carbon dioxide (pCO2) was 42 mmHg, partial pressure of oxygen (pO2) was 28 mmHg, carboxyhemoglobin (COHb) was 12.7% (reference interval: 0.5%-2.5%) and oxygen saturation was 52.4%. Electrocardiogram (ECG) examination showed that the patient was not in sinus rhythm but had atrial fibrillation. After three hours the laboratory examination was repeated: Troponin was 1.2 pg/ml and in the arterial blood gas COHb was 3%. The examination of the findings on the monitor showed that the sinus rhythm was re-established. The repeated ECG examination confirmed the conversion to the sinus rhythm. He was monitored with the normobaric oxygen administration.

scholarly journals PSIX-9 Impacts of bunk management on feedlot performance, carcass characteristics, hydrogen sulfide concentration and blood oxygen saturation in steers fed 25 or 50% modified distillers grains plus solubles

2020 ◽  
Vol 98 (Supplement_4) ◽  
pp. 422-422
Author(s):  
Rebecca L Moore ◽  
Cierrah J Kassetas ◽  
Leslie A LeKatz ◽  
Bryan W Neville
Keyword(s):  
Hydrogen Sulfide ◽  
Oxygen Saturation ◽  
Management Strategy ◽  
Distillers Grains ◽  
Feed Ratio ◽  
Sulfide Concentration ◽  
Blood Oxygen ◽  
Blood Oxygen Saturation ◽  
Feedlot Performance ◽  
Arterial Blood

Abstract One hundred and twenty-six yearling angus steers (initial body weight 445.87 ± 7.13 kg) were utilized in a 2 x 2 factorial design to evaluate the impacts of bunk management and modified distillers grains plus solubles (mDGS) inclusion on feedlot performance, hydrogen sulfide concentrations and blood oxygen saturation. Treatments included bunk management strategy either control bunk management (CON; clean bunks at the time of next day’s feeding) or long bunk management (LONG; feed remaining at time of next day’s feeding), and two inclusion rates of mDGS either 25% or 50% (DM Basis). On d 0, 7, 14, 21, 28 and 35 rumen gas samples were collected via rumenocentesis, and arterial blood samples were collected on two steers from each pen. No differences (P ≥ 0.09) were observed for dry matter intake, average daily gain and gain-to-feed ratio for bunk management or mDGS inclusion. Hot carcass weight, ribeye area, marbling score and quality grade were not affected (P ≥ 0.48) by either bunk management or mDGS inclusion. Back fat was greater (P = 0.04) for CON steers compared to LONG (1.30 vs 1.12 ± 0.05cm, respectively), but was not affected (P = 0.59) by mDGS inclusion. Steers on CON had greater (P = 0.03) yield grades compared to LONG (3.21 vs 2.96 ± 0.11, respectively). Bunk management strategy did not impact hydrogen sulfide concentrations or blood oxygen saturation (P = 0.82). Hydrogen sulfide concentrations increased (P < 0.001) with increasing mDGS inclusion. Blood oxygen saturation was influenced by day of sampling (P = 0.01). Blood oxygen saturation was not affected (P = 0.07) by mDGS inclusion. The fact that ruminal hydrogen sulfide concentrations increased while blood oxygen saturation remained similar raises questions about the quantity of hydrogen sulfide and metabolic fate of excess hydrogen sulfide in the blood of ruminant animals.

Reference intervals for venous blood gas measurement in adults

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Kirsty L. Ress ◽  
Gus Koerbin ◽  
Ling Li ◽  
Douglas Chesher ◽  
Phillip Bwititi ◽  
...  
Keyword(s):  
Partial Pressure ◽  
Meta Analysis ◽  
Venous Blood ◽  
Reference Interval ◽  
Reference Intervals ◽  
Published Data ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Venous Blood Gas

AbstractObjectivesVenous blood gas (VBG) analysis is becoming a popular alternative to arterial blood gas (ABG) analysis due to reduced risk of complications at phlebotomy and ease of draw. In lack of published data, this study aimed to establish reference intervals (RI) for correct interpretation of VBG results.MethodsOne hundred and 51 adult volunteers (101 females, 50 males 18–70 y), were enrolled after completion of a health questionnaire. Venous blood was drawn into safePICO syringes and analysed on ABL827 blood gas analyser (Radiometer Pacific Pty. Ltd.). A non-parametric approach was used to directly establish the VBG RI which was compared to a calculated VBG RI based on a meta-analysis of differences between ABG and VBGResultsAfter exclusions, 134 results were used to derive VBG RI: pH 7.30–7.43, partial pressure of carbon dioxide (pCO2) 38–58 mmHg, partial pressure of oxygen (pO2) 19–65 mmHg, bicarbonate (HCO3−) 22–30 mmol/L, sodium 135–143 mmol/L, potassium 3.6–4.5 mmol/L, chloride 101–110 mmol/L, ionised calcium 1.14–1.29 mmol/L, lactate 0.4–2.2 mmol/L, base excess (BE) −1.9–4.5 mmol/L, saturated oxygen (sO2) 23–93%, carboxyhaemoglobin 0.4–1.4% and methaemoglobin 0.3–0.9%. The meta-analysis revealed differences between ABG and VBG for pH, HCO3−, pCO2 and pO2 of 0.032, −1.0 mmol/L, −4.2 and 39.9 mmHg, respectively. Using this data along with established ABG RI, calculated VBG RI of pH 7.32–7.42, HCO3− 23 – 27 mmol/L, pCO2 36–49 mmHg (Female), pCO2 39–52 mmHg (Male) and pO2 43–68 mmHg were formulated and compared to the VBG RI of this study.ConclusionsAn adult reference interval has been established to assist interpretation of VBG results.

IN SITU MONITORING OF MEAN BLOOD OXYGEN SATURATION USING EXTENDED MODIFIED LAMBERT BEER MODEL

2015 ◽  
Vol 27 (01) ◽  
pp. 1550004 ◽  
Author(s):  
Audrey K. C. Huong ◽  
Xavier T. I. Ngu
Keyword(s):  
Oxygen Saturation ◽  
In Situ Monitoring ◽  
Blood Oxygen ◽  
Optical Monitoring ◽  
Hypertension Status ◽  
Blood Oxygen Saturation ◽  
Fitting Procedure ◽  
Arterial Blood ◽  
The Mean

We present the use of Extended Modified Lambert–Beer model for optical monitoring of mean blood oxygen saturation ( S m O 2) via a fitting procedure. This work focuses on the absorption characteristics of hemoglobin derivatives in the wavelength range of 520–600 nm to give the best estimates of S m O 2. The study of the feasibility of applying this analytic method to skin oximetry is via spectroscopy data collected from fingertips of four healthy volunteers both at rest and during arterial blood occlusion condition. The results revealed a decrease in the mean of mean and standard deviation of S m O 2 value of fingertips from 94.5 ± 2.19% when volunteers were at rest to 56.76 ± 5.8% during the arterial blood occlusion measurement. The larger variation in the value estimated for blood occlusion condition could be a result of differences in volunteers' physical fitness and hypertension status. These estimated S m O 2 values agreed reasonably well with the value reported in most of the previous studies. This work concluded that the proposed technique can potentially be used as a complementary technique to clinical assessment of skin grafts and burnt skin.

scholarly journals A Handheld Technology for Optical Monitoring of Transcutaneous Blood Oxygen Saturation

2018 ◽  
Vol 7 (3.20) ◽  
pp. 122 ◽  
Author(s):  
Audrey K.C. Huong ◽  
P E. Ong ◽  
V H. Tsen ◽  
Xavier T. I. Ngu
Keyword(s):  
Oxygen Saturation ◽  
Blood Oxygen ◽  
Blood Oxygen Saturation ◽  
Handheld Technology ◽  
Arterial Blood ◽  
Comprehensive Information ◽  
Rest Condition ◽  
Risk Of Exposure ◽  
Palm Of The Hand ◽  
532 Nm

This paper presents the use of a handheld technology for noninvasive prediction of one’s transcutaneous blood oxygen saturation, StO2, via an in-house developed skin oxygenation system. The quantification strategy involved the use of wavelength dependent Modified Lambert Beer law and is based on light signals of wavelengths 532 nm, 560 nm and 650 nm reflected from the selected skin site. This study performed at rest and arterial blood occlusion experiment on left palm of the hand of five healthy Asian volunteers to evaluate the performance of the system and to verify the validity of the predicted results. The preliminary results revealed a considerable decrease in the predicted mean percent StO2 value from 63.7 ± 13.2 % for at rest condition to 52.2 ± 11.4 % after a pressure of 140 mmHg was applied on upper left arm of these recruits for 120 seconds. This work concluded that the developed optical system is able to provide comprehensive information on spatially dependent StO2 and it has unlimited skin access, hence may be potentially used in field applications to assess the skin oxygen level of those in workforce whose job is at risk of exposure to poisonous gases. 

In Vivo Analysis of Gas Transport in Arterial and Venous Blood of the Sea Lamprey Petromyzon Marinus

1992 ◽  
Vol 169 (1) ◽  
pp. 105-119
Author(s):  
B. L. TUFTS ◽  
B. BAGATTO ◽  
B. CAMERON
Keyword(s):  
Partial Pressure ◽  
Whole Blood ◽  
Venous Blood ◽  
Recovery Period ◽  
Co2 Concentration ◽  
Extracellular Acidosis ◽  
Arterial Blood ◽  
Sea Lampreys ◽  
In Vivo Analysis

Exercise in sea lampreys resulted in a significant decrease in the extracellular pH (pHe) in both arterial and venous blood. At rest, the erythrocyte pH (pHi) of venous blood was significantly greater than the pHi of arterial blood. Despite the considerable extracellular acidosis after exercise, both arterial and venous pHi were maintained throughout the recovery period. In the venous blood, there was a reversal of the pH gradient (ΔpH) across the erythrocyte membrane immediately after exercise. Exercise also resulted in significant reductions in the partial pressure of oxygen and hemoglobin oxygen-carriage and a significant increase in the partial pressure of CO2 in arterial and venous blood. Although the total CO2 concentration of the plasma decreased after exercise, erythrocyte total CO2 concentrations (CCOCO2,i) increased. In venous blood, the CCOCO2,i immediately after exercise was double the resting value. At rest, partitioning of the total CO2 content between plasma and erythrocytes indicated that 16 % and 22 % of the total CO2 could be attributed to the erythrocytes in arterial and venous whole blood, respectively. After exercise, these percentages increased to 25% (arterial) and 38% (venous). Changes in CCOCO2,i accounted for 62% of the arteriovenous difference in whole-blood total CO2 at rest. This increased to 78% immediately after exercise. Thus, unlike other vertebrates, CO2 transport in the lamprey in vivo is largely dependent on erythrocyte CO2-carriage.

Feasıbılıty of Transcutaneous Method for Carbon Dıoxıde Monıtorıng in an Intensive Care Unıt

2022 ◽  
Vol 18 ◽  
Author(s):  
Nazlıhan Boyacı ◽  
Sariyya Mammadova ◽  
Nurgül Naurizbay ◽  
Merve Güleryüz ◽  
Kamil İnci ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Partial Pressure ◽  
Blood Gas ◽  
Peripheral Oxygen Saturation ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Randomized Controlled Studies ◽  
Significant Difference

Background: Transcutaneous partial pressure of carbon dioxide (PtCO2) monitorization provides a continuous and non-invasive measurement of partial pressure of carbon dioxide (pCO2). In addition, peripheral oxygen saturation (SpO2) can also be measured and followed by this method. However, data regarding the correlation between PtCO2 and arterial pCO2 (PaCO2) measurements acquired from peripheric arterial blood gas is controversial. Objective: We aimed to determine the reliability of PtCO2 with PaCO2 based on its advantages, like non-invasiveness and continuous applicability. Methods: Thirty-five adult patients with hypercapnic respiratory failure admitted to our tertiary medical intensive care unit (ICU) were included. Then we compared PtCO2 and PaCO2 and both SpO2 measurements simultaneously. Thirty measurements from the deltoid zone and 26 measurements from the cheek zone were applied. Results: PtCO2 could not be measured from the deltoid region in 5 (14%) patients. SpO2 and pulse rate could not be detected at 8 (26.7%) of the deltoid zone measurements. Correlation coefficients between PtCO2 and PaCO2 from deltoid and the cheek region were r: 0,915 and r: 0,946 (p = 0,0001). In comparison with the Bland-Altman test, difference in deltoid measurements was -1,38 ± 1,18 mmHg (p = 0.252) and in cheek measurements it was -5,12 ± 0,92 mmHg (p = 0,0001). There was no statistically significant difference between SpO2 measurements in each region. Conclusion: Our results suggest that PtCO2 and SpO2 measurements from the deltoid region are reliable compared to the arterial blood gas analysis in hypercapnic ICU patients. More randomized controlled studies investigating the effects of different measurement areas, hemodynamic parameters, and hemoglobin levels are needed.

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