Severe methemoglobinemia due to ingestion of toxicants

D'sa, Shilpa Reynal; Victor, Peter John; Jagannati, Manjeera; Sudarsan, Thomas Isaiah; Carey, Ronald Albert Benton; Peter, John Victor

doi:10.3109/15563650.2014.947377

Cited by 20 publications

(12 citation statements)

References 9 publications

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“…In patients with acute acquired methemoglobinemia who are symptomatic or have methemoglobin levels > 20 a single dose of one to two mg/kg of methylene blue should be given over five minutes, within 10–60 minutes of symptom onset. The response is typically very quick and a second dose is rarely required except in severe cases 18. In severe methemoglobinemia, patients should be managed in an ICU setting for close monitoring and stabilization of their airway, breathing, and circulation.…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, ascorbic acid may be used to treat acquired methemoglobinemia, especially in those patients with glucose-6-phosphate dehydrogenase deficiency (G6PD) where methylene blue is contraindicated, or, if methylene blue is not available. Therapeutic doses of methylene blue may lead to severe hemolysis of erythrocytes especially in patients with G6PD; if ascorbic acid is used, multiple doses are often required over 24 hours or more 17,19,20…”

Section: Discussionmentioning

confidence: 99%

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Code Blue: Life-threatening Methemoglobinemia

Ríos

Yong

Calner

2019

Clinical Practice and Cases in Emergency Medicine

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Most cases of acquired methemoglobinemia result from exposure to certain drugs or toxins. One of the more common and well-described causes in the literature is exposure to topical benzocaine during medical procedures. We present a case series of acute acquired methemoglobinemia from a food source that has not been previously described in the literature: a dessert. Three patients, ages 5, 33, and 86 years, were brought to our emergency department by ambulance after becoming extremely ill from ingesting a dessert containing nitre powder at a family gathering. They all presented with hypotension, cyanosis, and hypoxia that was not responsive to oxygen administration. The adult patients had major improvement of symptoms after a single dose of methylene blue. In contrast, the 5-year-old child who had the worst symptoms minimally improved with administration of two doses of methylene blue requiring intensive care admission and transfer to a tertiary care center.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Code Blue: Life-threatening Methemoglobinemia

Ríos

Yong

Calner

2019

Clinical Practice and Cases in Emergency Medicine

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“…When methylene blue is unavailable, ascorbic acid can be used, although multiple doses are required, and its response is less effective. As an alternative to methylene blue, ascorbic acid can be a therapeutic agent for methemoglobinemia in some cases [ 19 - 21 , 26 ]. Ascorbic acid, the most investigated antioxidant and free radical scavenger in the literature, reduces methemoglobin directly [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, methylene blue could induce hemolysis, and should not be administered to patients with known glucose-6-phosphate dehydrogenase (G6PD) deficiency and non-G6PD deficiency infants [ 17 , 18 ]. As an alternative to methylene blue, ascorbic acid has been used to treat methemoglobinemia, although multiple doses are required, and its response is very slow [ 19 - 21 ].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic effect of ascorbic acid on dapsone-induced methemoglobinemia in rats

Kang

Kim

et al. 2018

Clin Exp Emerg Med

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ObjectiveDapsone (diaminodiphenyl sulfone, DDS) is currently used to treat leprosy, malaria, dermatitis herpetiformis, and other diseases. It is also used to treat pneumocystis pneumonia and Toxoplasma gondii infection in HIV-positive patients. The most common adverse effect of DDS is methemoglobinemia from oxidative stress. Ascorbic acid is an antioxidant and reducing agent that scavenges the free radicals produced by oxidative stress. The present study aimed to investigate the effect of ascorbic acid in the treatment of DDS induced methemoglobinemia.MethodsMale Sprague-Dawley rats were divided into three groups: an ascorbic acid group, a methylene blue (MB) group, and a control group. After DDS (40 mg/kg) treatment via oral gavage, ascorbic acid (15 mg/kg), MB (1 mg/kg), or normal saline were administered via tail vein injection. Depending on the duration of the DDS treatment, blood methemoglobin levels, as well as the nitric oxide levels and catalase activity, were measured at 60, 120, or 180 minutes after DDS administration.ResultsMethemoglobin concentrations in the ascorbic acid and MB groups were significantly lower compared to those in the control group across multiple time points. The plasma nitric oxide levels and catalase activity were not different among the groups or time points.ConclusionIntravenous ascorbic acid administration is effective in treating DDS-induced methemoglobinemia in a murine model.

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“…can cause intoxication, shortness of breath, dizziness, fainting and other symptoms through inhalation or absorption through the skin, resulting in methemoglobinemia, emphysema, cardiovascular disease, and central nervous system disease [6,7]. Nitrobenzene compounds are listed as possible carcinogens by the United States Environmental Protection Agency (EPA) [8,9].…”

Section: Introductionmentioning

confidence: 99%