Reference values for methemoglobin concentrations in children

Rechetzki, Kely Francini; Henneberg, Raílson; Silva, Paulo Henrique da; Nascimento, Aguinaldo José do

doi:10.5581/1516-8484.20120007

Cited by 17 publications

(12 citation statements)

References 5 publications

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“…Thus, hypotension could be a problem in the elderly, or in subjects with autonomic insufficiency, such as diabetics. Methemoglobin production is a concern in infants and young children due to reduced methemoglobin reductase activity, and in people who are deficient in glucose-6 phosphate dehydrogenase activity (39;40). Because of the NO and methemoglobin generation, Nithiodote carries an FDA “Black Box” warning (http://www.drugs.com/pro/nithiodote.html).…”

Section: Discussionmentioning

confidence: 99%

Sodium Nitrite and Sodium Thiosulfate Are Effective Against Acute Cyanide Poisoning When Administered by Intramuscular Injection

Bebarta

Brittain

Chan

et al. 2017

Annals of Emergency Medicine

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Study Objective The two antidotes for acute cyanide poisoning in the United States must be given by intravenous injection. In the pre-hospital setting, intravenous injection is not practical, particularly for mass casualties, and intramuscular injection would be preferred. The purpose of this study was to determine if sodium nitrite and sodium thiosulfate are effective cyanide antidotes when given by intramuscular injection. Methods We used a randomized, non-blinded, parallel group study design in three mammalian models: cyanide gas inhalation in mice, with treatment post exposure; intravenous sodium cyanide infusion in rabbits, with severe hypotension as the trigger for treatment; and intravenous potassium cyanide infusion in pigs, with apnea as the trigger for treatment. The drugs were administered by intramuscular injection, and all three models were lethal in the absence of therapy. Results We found that sodium nitrite and sodium thiosulfate individually rescued 100% of the mice, and that the combination of the two drugs rescued 73% of the rabbits and 80% of the pigs. In all three species, survival in treated animals was significantly better than in control animals (log rank test, p < 0.05). In the pigs, the drugs attenuated a rise in the plasma lactate concentration within five minutes post-antidote injection (difference: plasma lactate, saline-versus nitrite-thiosulfate-treated 1.76 [95% confidence interval 1.25-2.27]). Conclusion We conclude that sodium nitrite and sodium thiosulfate given by intramuscular injection are effective against severe cyanide poisoning in three clinically relevant animal models of prehospital emergency care.

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Section: Discussionmentioning

confidence: 99%

Sodium Nitrite and Sodium Thiosulfate Are Effective Against Acute Cyanide Poisoning When Administered by Intramuscular Injection

Bebarta

Brittain

Chan

et al. 2017

Annals of Emergency Medicine

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“…Reference values for MetHb are more consistent, usually with an upper limit of 1%-1.5% [20,23,24]. However, a recent study reported that reference values for healthy children in Parana, Brazil were much higher (3.6%-6.4%) than for adults (1.9%-3.8%) illustrating the difficulty to find clear-cut values [25]. It thus appears doubtful if the measurement of COHb is a reliable way to assess haemolysis and disease severity.…”

Section: Discussionmentioning

confidence: 99%

Methaemoglobin and COHb in patients with malaria

Hänscheid

Gresnigt

Löhr

et al. 2014

Malar J

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BackgroundHaemolytic conditions may contribute to disease pathogenesis and severe clinical manifestations through the liberation of free haemoglobin (Hb) and production of toxic free haem. Thus, free Hb and haem should be associated with altered MetHb and COHb levels in malaria as in other conditions.MethodsThis study comprises data collected at three different sites: (i) a retrospective analysis of the first arterial blood gas result (ABGS) of any patient during 2010 at the University Hospital in Lisbon; (ii) a retrospective analysis of ABGS from patients with severe malaria admitted to the intensive care unit in Berlin, Germany; and (iii) a prospective study of non-invasive MetHb measurements in children with and without malaria in Lambaréné, Gabon.ResultsIn Lisbon, the mean MetHb level was 1.4% (SD: 0.5) in a total of 17,834 ABGS. Only 11 of 98 samples with a MetHb level of >3.0 referred to infections. COHb levels showed no particular association with clinical conditions, including sepsis. In 13 patients with severe malaria in Berlin, the mean MetHb levels on admission was 1.29%, with 1.36% for cerebral malaria and 1.14% for non-cerebral malaria (P > 0.05). All COHb measurements were below 2.3%. In Lambaréné, Gabon, 132 healthy children had a mean MetHb level of 1.57%, as compared to 150 children with malaria, with a value of 1.77% and 2.05% in uncomplicated and complicated cases, respectively (P < 0.01).ConclusionsThe data appears consistent with the methaemoglobin/haem hypothesis in malaria and sepsis pathogenesis. However, although MetHb was significantly different between healthy controls and children with malaria in Africa, the difference was rather small, also when compared to previous studies. Still, non-invasive bedside MetHb testing may warrant further evaluation as it could be a simple adjuvant tool for prognosis in resource poor settings.

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“…Adverse events not directly related to NO included events such as fever, otitis media, rash, diarrhea, and ear ache. Safety threshold for NO 2 and MetHb was set at 5 ppm and 5%, respectively, based on the neonatal inhaled NO study …”

Section: Methodsmentioning

confidence: 99%

“…Evaluation included disease severity determination via clinical score (Table ) . Subjects were examined and evaluated using the score twice daily.…”

Section: Methodsmentioning

confidence: 99%

Nitric oxide inhalations in bronchiolitis: A pilot, randomized, double‐blinded, controlled trial

Tal

Greenberg

Av‐Gay

et al. 2017

Pediatric Pulmonology

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Aim: The aims of this pilot study were to determine safety, tolerability (primary outcome) and efficacy (secondary outcome) of high-dose inhaled nitric oxide for the treatment of infants with moderately severe bronchiolitis.Methods: This was a pilot, double-blinded, randomized controlled study (phase IIa).Intermittent inhalations of nitric oxide 160 ppm for 30 min or oxygen/air (control) were given 5 times/day to hospitalized infants (2-11 months) with acute bronchiolitis. Oxygen saturation, methemoglobin, and nitric dioxide (NO 2 ) levels and vital signs were monitored.Results: Forty-three infants were enrolled. Baseline characteristics were comparable in both study groups. Mean clinical score, comprised of four components: respiratory rate, use of accessory muscles, wheezes and crackles, and % room-air oxygen saturation, was 7.86 (±1.1) and 8.09 (±1.2) in the NO and control groups, respectively, consistent with moderate severity. The overall frequency of adverse events was similar between the groups. Repeated nitric oxide inhalations did not result in increased inhaled NO 2 levels or cumulative effect on methemoglobin levels. Secondary outcomes of efficacy were measured by length of hospitalization (LOS) in hours:LOS did not differ between groups. However, in a post-hoc analysis of a subgroup of infants hospitalized for >24 h (n = 24), the median LOS was shorter in the nitric oxide (41.9 h) than in the control group (62.5 h) (P = 0.014). Conclusion:Our study was unable to detect a difference in side effects using intermittent high-dose nitric-oxide inhalation or supportive treatment alone, in infants with moderate bronchiolitis. Preliminary efficacy outcomes are encouraging.

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Reference values for methemoglobin concentrations in children

Cited by 17 publications

References 5 publications

Sodium Nitrite and Sodium Thiosulfate Are Effective Against Acute Cyanide Poisoning When Administered by Intramuscular Injection

Sodium Nitrite and Sodium Thiosulfate Are Effective Against Acute Cyanide Poisoning When Administered by Intramuscular Injection

Methaemoglobin and COHb in patients with malaria

Nitric oxide inhalations in bronchiolitis: A pilot, randomized, double‐blinded, controlled trial

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