A Case of Sodium Chlorite Toxicity Managed with Concurrent Renal Replacement Therapy and Red Cell Exchange

Abstract

IntroductionSodium chlorite is a powerful oxidizing agent with multiple commercial applications. We report the presentation and management of a single case of human toxicity of sodium chlorite.Case reportA 65-year-old man presented to hospital after accidentally ingesting a small amount of a sodium chlorite solution. His principal manifestations were mild methemoglobinemia, severe oxidative hemolysis, disseminated intravascular coagulation, and anuric acute kidney injury. He was managed with intermittent hemodialysis, followed by continuous venovenous hemofiltration for management of acute kidney injury and in an effort to remove free plasma chlorite. Concurrently, he underwent two red cell exchanges, as well as a plasma exchange, to reduce the burden of red cells affected by chlorite. These interventions resulted in the cessation of hemolysis with stabilization of serum hemoglobin and platelets. The patient survived and subsequently recovered normal renal function.DiscussionThis is only the second case of sodium chlorite intoxication reported in the medical literature and the first to report the use of renal replacement therapy in combination with red cell exchange in its management.

A Case of Severe Chlorite Poisoning Successfully Treated With Early Administration of Methylene Blue, Renal Replacement Therapy, and Red Blood Cell Transfusion

“…Based on our and the previous 2 reported cases, it seems that MetHb formation is dependent on the amount of chlorite ingested. In the case of Lin and Lim, 1 the patient who was presented with >50% MetHb had ingested a teacup of 10% chlorite, whereas in the second case (Romanovsky et al 2 ), MetHb was around 6% in a patient who had ingested a mouthful of 28% chlorite diluted with water in a cup. Our patient had ingested <100 mL of 28% chlorite, rendering a MetHb level of 40%.…”

“…MB in this case had no effect on MetHb formation (MetHb about 50%). In the second case (Romanovsky et al, 2 MetHb about 10%), the patient was treated with IHD, continuous venovenous hemofiltration (CVVH), and red blood cell exchange. In both cases, the patients developed hemolysis, DIC, and acute renal failure that required IHD for renal recovery, and both patients survived.…”

Kikuchi-Fujimoto disease presenting after consumption of ‘Miracle Mineral Solution’ (sodium chlorite)

“…There are only two reported cases of human intoxication with sodium chlorite. One patient ingested an unmeasured amount of 28% sodium chlorite solution diluted with water 11. The other patient ingested 10 g diluted in 100 mL of water 12.…”

Chlorite reactivity with myoglobin: Analogy with peroxide and nitrite chemistry?

“…The physiological effects of exogenous sodium chlorite on humans and animals include some reported cases of methemoglobinemia, hemolysis and glutathione depletion [29], [30]. These medical links to globin chemistry provide an additional point of interest for the present investigation, besides generally trying to investigate hemoprotein-hypochlorite interactions with relevance to chlorite dismutases [31], [32] and to some extent haloperoxidases (chloroperoxidase, myeloperoxidase, and others [8], [33], [34].…”