Methemoglobinemia as an uncommon cause of cyanosis

Demirel, Hande; Koster, V.S; Koot, M.J; Ponssen, H. H.; Vliet, A. C. M. Van

doi:10.1016/s0300-2977(98)00144-2

“…The few occupational cases that have been documented have occurred in aniline dye production,11-13 in pharmaceutical,14 pesticide15 or rubber manufacture,16 in the electronics industry,17during transportation or waste disposal of methaemoglobin forming agents18 or in maintenance work 19. Two case series reporting a total of 512 cases were published separately in 1964 and 1986 11…”

Section: Agents and Industriesmentioning

confidence: 99%

Occupational Methaemoglobinaemia

Bradberry

¹

2001

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Methaemoglobin is haemoglobin in which haem iron is oxidised to iron (III) and therefore cannot function as an eVective oxygen transporting protein. Small amounts of methaemoglobin are produced continually, but the proportion of total haemoglobin that is present as methaemoglobin is maintained at around 1% by the action of an NADH dependent methaemoglobin reductase. A methaemoglobin concentration greater than 1% (methaemoglobinaemia) ensues if the rate of methaemoglobin formation exceeds its rate of reduction. Not only is methaemoglobin incapable of binding oxygen but, in addition, the oxidation of one or more of the haem iron atoms in the haem tetramer distorts the tetramer structure, so that the remaining nonoxidised haem subunits bind oxygen avidly but release it less eYciently, which shifts the oxygen dissociation curve to the left. Methaemoglobinaemia manifests therefore as tissue hypoxia.

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Methemoglobinemia resulting from exposure in a confined space: Exothermic self-polymerization of 4,4′-methylene diphenyl diisocyanate (MDI) material

Smith

¹

,

Lodwick

²

,

Dartt

³

et al. 2016

Journal of Occupational and Environmental Hygiene

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A worker attempting to remove solidified material inside a confined space (storage tank) suffered severe methemoglobinemia and almost died. The tank contained liquid 4,4'-methylene diphenyl diisocyanate monomer that had solidified after an equipment power failure caused excessive heating. Wearing a full-face elastomeric air-purifying respirator and Tyvek® coveralls, the worker used pneumatic air hammers to break up the solid material. After two tank entries totaling slightly less than one hour, the worker complained of headache and dizziness and within two hours of exiting the tank, he was admitted to the hospital in severe respiratory distress. During his eight-week hospital course, he suffered a cardiac arrest among other complications. An investigation into the cause of the worker's illness used onsite gas chromatography-mass spectrometry which identified aniline and p-toluidine vapor within the tank, attributable to overheating that led to formation of the solid material. Both are well-known causes of methemoglobinemia, and had the initial characterization of the confined space atmosphere adequately identified the hazards present appropriate engineering controls and personal protective equipment could have allowed the tank entrant to work safely in the space.

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Occupational Methaemoglobinaemia

Bradberry

¹

2003

Toxicological Reviews

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Methaemoglobin is haemoglobin in which haem iron is oxidised to iron (III) and therefore cannot function as an eVective oxygen transporting protein. Small amounts of methaemoglobin are produced continually, but the proportion of total haemoglobin that is present as methaemoglobin is maintained at around 1% by the action of an NADH dependent methaemoglobin reductase. A methaemoglobin concentration greater than 1% (methaemoglobinaemia) ensues if the rate of methaemoglobin formation exceeds its rate of reduction. Not only is methaemoglobin incapable of binding oxygen but, in addition, the oxidation of one or more of the haem iron atoms in the haem tetramer distorts the tetramer structure, so that the remaining nonoxidised haem subunits bind oxygen avidly but release it less eYciently, which shifts the oxygen dissociation curve to the left. Methaemoglobinaemia manifests therefore as tissue hypoxia.

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Methemoglobinemia as an uncommon cause of cyanosis

Cited by 4 publications

References 7 publications

Occupational Methaemoglobinaemia

Occupational Methaemoglobinaemia

Methemoglobinemia resulting from exposure in a confined space: Exothermic self-polymerization of 4,4′-methylene diphenyl diisocyanate (MDI) material

Occupational Methaemoglobinaemia

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