Methylene Blue for Distributive Shock: A Potential New Use of an Old Antidote

Jang, David H.; Nelson, Lewis S.; Hoffman, Robert S.

doi:10.1007/s13181-013-0298-7

Cited by 99 publications

(102 citation statements)

References 87 publications

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“…Other medications or therapies that can be considered for refractory shock include methylene blue or lipid emulsion therapy. 63 Neither of these treatments has been evaluated in the setting of OP or carbamate poisoning and should be considered off-label indications.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Organophosphate and Carbamate Poisoning

King

Aaron

2015

Emergency Medicine Clinics of North America

231

147

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Section: Clinical Manifestationsmentioning

confidence: 99%

Organophosphate and Carbamate Poisoning

King

Aaron

2015

Emergency Medicine Clinics of North America

231

147

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“…Various case reports on anaphylactic shock27–32 and septic shock18 have documented the use of single or repeated boluses or an infusion with or without a bolus. Dosing of methylene blue for methaemoglobinaemia is typically 1–2 mg/kg of a 1% solution, intravenously 33.…”

Section: Discussionmentioning

confidence: 99%

A severe case of vasoplegic shock following metformin overdose successfully treated with methylene blue as a last line therapy

Graham¹,

Cartner

Winearls

2015

BMJ Case Reports

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A 44-year-old man presented to hospital 24 h after an intentional overdose of metformin and gliclazide. He had a critical metabolic acidosis on presentation with a pH of 6.88, and very rapidly deteriorated into distributive shock refractory to large volume fluid resuscitation and massive doses of vasopressors. We introduced a methylene blue infusion as a rescue therapy in an attempt to improve the patient's haemodynamics, which was successful. The patient made a full recovery with no long-term sequelae.

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“…Due to these characteristics, the compound has a remarkable antioxidant activity, which is utilized in many areas (3). Moreover, it has an inhibitory effect on nitric oxide synthase and guanylate cyclase (16).…”

Section: Principal Compounds With Phenothiazine Skeleton and Their Stmentioning

confidence: 99%

Possible Biological and Clinical Applications of Phenothiazines

Varga

Csonka

et al. 2017

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Abstract. Phenothiazines have been used in many areasPhenothiazines are unanimously one of the most versatile compounds from the view of biological activity. Since their discovery, new exploitable pharmacological properties have emerged from time to time; thus, they have an important role in many areas of medicine and beyond. This is why phenothiazines are basic compounds in pharmacology. The history of these compounds goes back to the second half of the 19th century, when a German chemist, Heinrich August Bernthsen began to study the structure of methylene blue, which was first synthesized in 1876 by Heinrich Caro. In 1885, two years after Bernthsen first managed to produce phenothiazine, he also succeeded in describing the structure of methylene blue (1). At the same time, Paul Ehrlich began to investigate the possible therapeutic use of methylene blue in malaria infections, which he first published in 1891 (2). Due to this, methylene blue was often prescribed for patients with malaria in the subsequent period (3).Research conducted in the 1930s and '40s proved the potential wide use of phenothiazines. The insecticidal (4), antihelmintic (5, 6), and antibacterial (7) effects of the compound were detected; however, it was not widely used for these purposes. In the 1940s, another novel phenothiazine derivative, namely promethazine was brought to the forefront of attention; it was investigated by Paul Charpentier at the Rhone-Poulenc laboratory in Paris (8). It was shown that promethazine had an antihistamine effect (9), which was later used in the therapy of allergic diseases and in anesthesia (10,11). A few years later in the same laboratory, chlorpromazine was discovered, which has strong anxiolytic and antipsychotic effect along with its antihistaminic effect (12). Psychiatry fully exploited this feature in psychotic patients (13), which resulted in the almost complete emptying of psychiatric hospitals in the 1950s. As a result, the discovery of chlorpromazine and the beginning of its use as an antipsychotic are considered the beginning of modern psychiatry and psychopharmacology.Since then, several antipsychotic phenothiazine compounds have been used in clinical practice, although research conducted in the last couple of decades indicated that phenothiazine compounds could have an important role in other fields of medicine as well, such as in the treatment of tumorous, infectious, or neurodegenerative diseases (3). 5983

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Methylene Blue for Distributive Shock: A Potential New Use of an Old Antidote

Cited by 99 publications

References 87 publications

Organophosphate and Carbamate Poisoning

Organophosphate and Carbamate Poisoning

A severe case of vasoplegic shock following metformin overdose successfully treated with methylene blue as a last line therapy

Possible Biological and Clinical Applications of Phenothiazines

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