scholarly journals The Pharmacotherapy of Blood Intoxication (Methmoglobinemia) Induce by Exposure to Ortho-Chlorobenzylidenemalononitrile (CS) in Public Protests

2020 ◽  
pp. 18-21
Author(s):  
Muhi N. Salman
Keyword(s):  
Methylene Blue ◽  
Hydrogen Cyanide ◽  
Ferrous Iron ◽  
Oxygen Therapy ◽  
Methemoglobin Level ◽  
Level Of Consciousness ◽  
Appropriate Therapy ◽  
Mild Hypoxia ◽  
Current Exposure ◽  
Morbid Conditions

Background: Acquired Methemoglobinemia(MetHb) is a rare, but potentially serious and unfamiliarity with this complication may delay diagnosis and appropriate therapy. Presentation: A case  of methemoglobinemia occurring in male teenage  demonstrator as a complication of re-current  exposure  to ortho-chlorobenzylidenemalononitrile (CS)  in public protests , the patient became cyanotic with a decrease in his level of consciousness, by the effect of hydrogen cyanide as by-product of (CS),  resulting in a  toxic methemoglobinemia level in his blood.  Methemoglobin is incapable of carrying oxygen and is formed when the ferrous iron in the heme molecule is oxidized to the ferric state. The diagnosis should be entertained when cyanosis, unresponsive to 100% oxygen therapy, appears suddenly, especially when exposure to an oxidant agent is established. Treatment: The patient received a 1 mg/kg dose of methylene blue intravenously. A cooximetry done 1 hour later showed a methemoglobin level of 43%. A second 1 mg/kg dose of methylene blue was given and another hour later the methemoglobin level had dropped to 13%. The patient also showed clinical improvement with resolution of the cyanosis and return of his mental status to baseline. Conclusion: Methylene blue is the specific antidote, but should be reserved for more severe cases or if co-morbid conditions make mild hypoxia un advisable.

scholarly journals Severe Methemoglobinemia due to Sodium Nitrite Poisoning

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Kenichi Katabami ◽  
Mineji Hayakawa ◽  
Satoshi Gando
Keyword(s):  
Intensive Care Unit ◽  
Methylene Blue ◽  
Sodium Nitrite ◽  
Blood Test ◽  
Gastric Lavage ◽  
Accurate Diagnosis ◽  
Loss Of Consciousness ◽  
Methemoglobin Level ◽  
Neurologic Impairment ◽  
Transient Loss

Case. We report a case of severe methemoglobinemia due to sodium nitrite poisoning. A 28-year-old man was brought to our emergency department because of transient loss of consciousness and cyanosis. He was immediately intubated and ventilated with 100% oxygen. A blood test revealed a methemoglobin level of 92.5%.Outcome. We treated the patient with gastric lavage, activated charcoal, and methylene blue (2 mg/kg) administered intravenously. Soon after receiving methylene blue, his cyanosis resolved and the methemoglobin level began to decrease. After relocation to the intensive care unit, his consciousness improved and he could recall ingesting approximately 15 g sodium nitrite about 1 hour before he was brought to our hospital. The patient was discharged on day 7 without neurologic impairment.Conclusion. Severe methemoglobinemia may be fatal. Therefore, accurate diagnosis of methemoglobinemia is very important so that treatment can be started as soon as possible.

scholarly journals A Case Report of Prilocaine-Induced Methemoglobinemia after Liposuction Procedure

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Birdal Yildirim ◽  
Ulku Karagoz ◽  
Ethem Acar ◽  
Halil Beydilli ◽  
Emine Nese Yeniceri ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Emergency Service ◽  
Age Group ◽  
Shortness Of Breath ◽  
Blood Gas ◽  
Medicine Department ◽  
Arterial Blood Gas ◽  
Adult Age ◽  
Methemoglobin Level ◽  
Arterial Blood

Prilocaine-induced methemoglobinemia is a rarely seen condition. In this paper, a case is presented with methemoglobinemia developed secondary to prilocaine use in a liposuction procedure, and the importance of this rarely seen condition is emphasized. A 20-year-old female patient presented with complaints of prostration, lassitude, shivering, shortness of breath, and cyanosis. It was learned that the patient underwent nearly 1000 mg prilocaine infiltration 8 hours priorly during a liposuction procedure. At admission, her blood pressure (130/80 mmHg), pulse rate (140 bpm), body temperature (36°C), and respiratory rate (40/min) were recorded. The patient had marked acrocyanosis. The arterial blood gas methemoglobin level was measured as 40%. The patient received oxygen therapy with a mask and was administered vitamin C in normal saline (500 mg tid), N-acetylcysteine (300 mg tid), and 50 mg 10% methylene blue in the intensive care unit of the internal medicine department. Methemoglobin level dropped down to 2% after her treatment with methylene blue and she was clinically cured and discharged 2 days later. Emergency service physicians should remember to consider methemoglobinemia when making a differential diagnosis between dyspnea and cyanosis developing after prilocaine infiltration performed for liposuctions in the adult age group.

Rasburicase-induced methemoglobinemia: The eyes do not see what the mind does not know

2017 ◽  
Vol 24 (4) ◽  
pp. 309-313 ◽  
Author(s):  
Uroosa Ibrahim ◽  
Amina Saqib ◽  
Farhan Mohammad ◽  
Jean Paul Atallah ◽  
Marcel Odaimi
Keyword(s):  
Adverse Effect ◽  
Methylene Blue ◽  
High Risk ◽  
Tumor Lysis Syndrome ◽  
B Cell Lymphoma ◽  
Respiratory Compromise ◽  
Tumor Lysis ◽  
Methemoglobin Level ◽  
Treatment Considerations ◽  
Life Threatening

Rasburicase is indicated for the prevention and treatment of tumor lysis syndrome which can be a potentially life-threatening emergency. The drug has oxidizing potential and as an adverse effect, it can convert the ferrous form of iron in erythrocytes to its ferric form resulting in the formation of methemoglobin which makes the heme component incapable of carrying oxygen. Patients with glucose-6-phosphate dehydrogenase enzyme deficiency are at high risk of methemoglobinemia from oxidizing agents. Symptoms of methemoglobinemia range from none to life-threatening hypoxemia, cyanosis and respiratory compromise. Treatment is indicated at levels above 20% and at lower levels if the patient is significantly anemic. We present a case of a 60-year-old male with diffuse large B cell lymphoma at high risk of tumor lysis syndrome. Rasburicase was administered to prevent renal failure and further rise in uric acid. Twenty-four hours later, a bedside pulse oximetry showed an oxygen saturation ranging from 60 to 65% with minimal cyanosis. Co-oximetry revealed a methemoglobin level of 9.8%. Methylene blue was administered and the methemoglobin level decreased to 2.6%. However, the patient developed hemolysis several hours later, likely secondary to rasburicase and methylene blue, requiring transfusion support. We discuss this potentially fatal and initially asymptomatic adverse effect of rasburicase along with diagnostic and treatment considerations, and review the cases described in the current literature.

The Methylene Blue—Ferrous Iron Reaction in a Two-Phase System1

1966 ◽  
Vol 70 (9) ◽  
pp. 3012-3014 ◽  
Author(s):  
D. Fraçkowiak ◽  
E. Rabinowitch
Keyword(s):  
Methylene Blue ◽  
Ferrous Iron ◽  
Two Phase

Methemoglobinemia in aluminum phosphide poisoning

2010 ◽  
Vol 30 (3) ◽  
pp. 250-253 ◽  
Author(s):  
Shahin Shadnia ◽  
Kambiz Soltaninejad ◽  
Hossein Hassan ian-Moghadam ◽  
Anahaita Sadeghi ◽  
Hormat Rahimzadeh ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Ascorbic Acid ◽  
Oxygen Therapy ◽  
Gastric Lavage ◽  
Aluminum Phosphide ◽  
Rare Finding ◽  
Significant Events ◽  
Common Causes ◽  
Aluminum Phosphide Poisoning ◽  
Acute Pesticide Poisoning

Introduction. Acute aluminum phosphide (AlP) poisoning is one of the most common causes of acute pesticide poisoning in Iran. Hydrogen phosphide or phosphine gas is produced following reaction of AlP with water even at ambient humidity. Methemoglobinemia is a rare finding following phosphine poisoning. In this paper, two cases of fatal AlP poisoning complicated by methemoglobinemia are reported. Case Report. Two patients presented following suicidal ingestion of AlP tablets. In the Emergency Department (ED), they received gastric lavage with sodium bicarbonate and potassium permanganate. Both of them received supportive care. In each case, hematuria and hemolysis were significant events. The patients also showed a decrease in O2 saturation in spite of high FIO2. Methemoglobin levels of 40% and 30% were detected by co-oximetry. Neither patient responded to treatment (ascorbic acid in one case, methylene blue in the other). Both patients died due to systemic effects of phosphine poisoning. Discussion and conclusion. Hemolysis and methemoglobinemia may complicate the course of phosphine poisoning that seems resistant to methylene blue and ascorbic acid. Therefore, other treatments including hyperbaric oxygen therapy and exchange blood transfusion should be considered.

scholarly journals A rare cause of cyanosis: Congenital methemoglobinemia

2021 ◽  
Author(s):  
RAHMA GUEDRI ◽  
Nada Missaoui ◽  
Leila ESSADDAM ◽  
SAAYDA Ben Becher
Keyword(s):  
Methylene Blue ◽  
Physical Examination ◽  
Oxygen Saturation ◽  
Consanguineous Marriage ◽  
Type I ◽  
Methemoglobin Level

A 13-month-old infant, born from a consanguineous marriage. She presented isolated cyanosis. Physical examination was normal. Pulsed oxygen saturation was 94% in room air. Methemoglobin level was 39.4%. The diagnosis of congenital methemoglobinemia type I was retained. She was successfully treated with methylene blue infusions and ascobic acid.

scholarly journals RASBURICASE INDUCED METHEMOGLOBINEMIA: A SYSTEMATIC REVIEW OF DESCRIPTIVE STUDIES

2021 ◽  
Author(s):  
BH Vidhyashree ◽  
Mohammed Zuber ◽  
Shifa Taj ◽  
Rajesh Venkatraman ◽  
BP Sathish Kumar ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Oxygen Therapy ◽  
Treatment Approach ◽  
Grey Literature ◽  
Data Abstraction ◽  
Careful Monitoring ◽  
Search Terms ◽  
Study Selection ◽  
Registration Number ◽  
Bibliographic Search

Abstract Purpose: There are an increased number of reports being published on rasburicase-induced methemoglobinemia recently. We aimed to identify and critically evaluate all the descriptive studies that described the rasburicase-induced methemoglobinemia, its treatment approach, and their outcomes. Methodology: PubMed and grey literature databases were searched from inception to January 2021 using search terms “rasburicase” and “methemoglobinemia” without any language and date restriction. A bibliographic search was also done to find additional studies. Only descriptive studies on Rasburicase-induced methemoglobinemia were included for our review. Two contributors worked independently on study selection, data abstraction, and quality assessment, and any disagreements were resolved by consensus or discussion with a third reviewer. Result: A total of 22 reports including 25 patients (21 male, 3 female patients, and 1 study did not specify the gender of the patient) aged from 6 to 75 years were included in the review. Immediate withdrawal of the drug and administering methylene blue, ascorbic acid, blood transfusion, and supportive oxygen therapy are the cornerstone in the management of rasburicase-induced methemoglobinemia. Conclusion: Rasburicase administration should be followed by careful monitoring of patients for any severe complication and treat it as early as possible appropriately. In a patient who presents with rasburicase-induced haemolysis or methemoglobinemia, it is often important to expect a diagnosis of G6PD deficiency unless otherwise confirmed and to avoid administering methylene blue, even though the patient is from a low-risk ethnicity for G6PDD. PROSPERO Registration number: CRD42021234132

Dapsone-Induced Methemoglobinemia in a Patient with Acute Lymphocytic Leukemia Admitted with Severe Legionella Pneumonia

2012 ◽  
Vol 47 (1) ◽  
pp. 42-46
Author(s):  
E. Martin Kelly ◽  
Daining Jonathan ◽  
P. Gonzales Jeffrey
Keyword(s):  
Methylene Blue ◽  
Severe Sepsis ◽  
Acute Lymphocytic Leukemia ◽  
Multiorgan Failure ◽  
Stable Condition ◽  
Lymphocytic Leukemia ◽  
Toxic Metabolite ◽  
Methemoglobin Level ◽  
Legionella Pneumonia ◽  
Antibacterial Medication

Dapsone is an antibacterial medication used as an alternative to the first-line therapy (sulfamethoxazole-trimethoprim) for Pneumocystis pneumonia prophylaxis. Methemoglobinemia is a known toxicity of dapsone. However, dapsone-induced methemoglobinemia in an acute lymphocytic leukemia (ALL) patient with severe Legionella pneumonia has not been previously reported. We describe a 37-year-old male with ALL who was admitted for severe Legionella pneumonia sepsis, rhabdomyolysis, and multiple organ failure. The patient was started on broad-spectrum antibiotics and subsequently intubated for respiratory failure. The patient's methemoglobin level was 24.5%. The repeat methemoglobin level was 28.7%; intravenous methylene blue 100 mg was given for a total of 2 doses after which the methemoglobin level decreased to 2.5%. The patient was extubated 4 days after the second dose of methylene blue. He was later discharged home in stable condition. This patient developed severe sepsis with multiorgan failure, which resulted in acute liver and renal insufficiencies. The decreased metabolism and excretion of dapsone and its toxic metabolite is the likely cause of methemoglobinemia in this patient. Immunocompromised oncology patients who develop severe sepsis require careful monitoring for dapsone-induced methemoglobinemia. Liver dysfunction and renal failure may both potentiate toxicity with prophylactic doses of dapsone.

Sign in / Sign up

Export Citation Format

Share Document