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At least 163 records · Page 9Linked to original sources

Methemoglobinemia after transesophageal echocardiography: a life-threatening complication.

Methemoglobinemia is an uncommon cause of tissue hypoxemia that can be life-threatening if not promptly identified and treated. It can occur after exposure to an oxidizing agent from contaminated well water or from nitroglycerin, sodium nitroprusside, or certain local anesthetics. During oropharyngeal use of topical anesthetics for transesophageal echocardiography, systemic drug uptake is unpredictable and unexplained complications can ensue. Treatment of acquired methemoglobinemia may require methylene blue, as oxygen is not usually sufficient. Avoidance of the oxidizing agent, probably benzocaine in the cases presented, is prudent.

Adult↗

A PACU crisis: a case study on the development and management of methemoglobinemia.

The development of methemoglobinemia requires rapid recognition, confirmation, and treatment. This case study describes the development, diagnosis, and management of a 63-year-old male scheduled for a laparoscopic cholecystectomy with an intraoperative cholangiogram who developed methemoglobinemia after benzocaine was given for intubation.

Anesthetics, Local↗

Drug-induced methemoglobinemia during thoracoscopic lung biopsy.

Acquired methemoglobinemia occurs rarely in clinical practice. We present a case of a 57-year-old man who developed severe drug-induced methemoglobinemia after exposure to benzocaine spray and lidocaine jelly during intubation for an elective thoracoscopic lung biopsy. Information regarding the classifications, pathophysiology, diagnosis, and treatment of this entity is reviewed.

Aerosols↗

An unusual case of hypoxia from benzocaine-induced methemoglobinemia.

Hypoxemia during bronchoscopy occurs frequently. It can usually be managed by supplemental oxygen and bronchodilators or, in some cases, occasionally stopping the procedure. Benzocaine spray is commonly used as a topical anesthetic agent during bronchoscopy. However, it has been associated with the development of methemoglobinemia. The following is a case report of hypoxia during bronchoscopy from benzocaine-induced methemoglobinemia and its management.

Aged↗

Antibody-based spot test for NADH-cytochrome b5 reductase activity for the laboratory diagnosis of congenital methemoglobinemia.

NADH (reduced Coenzyme I)-cytochrome b5 reductase (b5R) is a multifunctional redox enzyme, whose deficiency causes recessive congenital methemoglobinemia. A novel procedure for the detection of b5R activity in human hemolysates was developed, in which b5R monoclonal antibodies dot-blotted on nitrocellulose membrane was used to capture and enrich b5R from hemolysates, and the captured b5R activity was subsequently visualized with the substrate 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide. Application of this simple method to the detection of b5R activity in the hemolysates from different subjects demonstrated that it was both sensitive and reliable. Our method would be useful for the laboratory diagnosis of congenital methemoglobinemia.

Adult↗

Rebound severe methemoglobinemia from ingestion of a nitroethane artificial-fingernail remover.

We describe life-threatening methemoglobinemia in a child who ingested a nitroethane artificial-fingernail remover initially mistaken to be an acetone-based polish remover. Nitroethane-induced methemoglobinemia may be delayed and recurrent; patients ingesting this substance may warrant close observation for at least 24 hours. Care givers are cautioned to determine the precise substance involved in ingestions of potentially toxic fingernail products.

Cosmetics↗

Methemoglobinemia from topically applied anesthetic spray.

Topically applied anesthetic spray is commonly used as part of premedication for general anesthesia and for endoscopic procedures; it is rarely associated with side effects. In this report, we describe two cases of toxic methemoglobinemia that resulted from topically applied anesthetic spray used before endoscopy. In both cases, standard doses were used; however, methemoglobin levels of 45% and 38% developed within 1 hour of the procedure. Both patients had normal levels of erythrocyte methemoglobin reductase, an indication that this rare but potentially fatal side effect can occur in persons who have no predisposing factors. Because toxic methemoglobinemia is easily treated, our report emphasizes the need to recognize this problem when topically applied anesthetic sprays are used.

Administration, Topical↗

Methemoglobinemia from overdose of phenazopyridine hydrochloride.

A case of severe methemoglobinemia and hemolytic anemia following ingestion of 5.6 gm of phenazopyridine with suicidal intent by a 16-year-old woman was successfully treated with intravenous methylene blue. Methemoglobinemia was suspected in this patient because of her intense central cyanosis, chocolate-colored blood, and minimal dyspnea. The patient's peripheral blood smear exhibited "bite cells." To the best of our knowledge, this is only the third such case reported in the literature. The pathophysiology, diagnosis, and therapy are reviewed.

Adolescent↗

Methemoglobinemia from isobutyl nitrite preparations.

Ingestion of preparations containing isobutyl nitrite can lead to rapidly fatal methemoglobinemia. We report the cases of three patients presenting with methemoglobinemia secondary to ingestion or inhaling the contents of an over-the-counter room odorizer preparation containing isobutyl nitrite. The condition was treated successfully with administration of intravenous methylene blue.

Adolescent↗

Methemoglobinemia.

Methemoglobinemia must be considered in the differential diagnosis of the cyanotic patient. Methemoglobin cannot carry oxygen or carbon dioxide. Methemoglobinemia can result from exposure to a wide variety of chemicals, including many commonly prescribed drugs, usually in an overdose situation. Most cases require only supportive therapy and assessment for other toxic complications. Severe cases may result in hypoxia and require treatment with methylene blue. Not all cases respond to methylene blue, and methylene blue itself may produce serious side effects.

Adult↗

Methemoglobinemia due to ingestion of at most three pills of pyridium in a 2-year-old: case report and review.

Pyridium (phenazopyridine HCl) is a commonly prescribed medication in the treatment of urinary tract infections and is known to cause methemoglobinemia in excessive doses. We report the case of a 2-year-old child who ingested a maximum of three 200-mg tablets (approximately 50 mg/kg) of pyridium and yet developed cyanosis and methemoglobinemia (29.1%), resulting in methylene blue therapy. We urge physicians to consider a period of observation (4-6 h) or to obtain methemoglobin levels in children who ingest even a small number of pyridium tablets because this can represent a toxic dose in a small child.

Anesthetics, Local↗

Heterologous expression of enzymopenic methemoglobinemia variants using a novel NADH:cytochrome c reductase fusion protein.

Hereditary enzymopenic methemoglobinemia is a rare disease that predominantly results from defects in either the erythrocytic (type I) or microsomal (type II) forms of the enzyme NADH:cytochrome b5 reductase (EC 1.6.2.2). All 25 currently identified type I and type II methemoglobinemia mutants have been expressed in Escherichia coli using a novel six histidine-tagged rat cytochrome b5/cytochrome b5 reductase fusion protein designated NADH:cytochrome c reductase (H6NCR). All 25 H6NCR variants were isolated and demonstrated to result in two groups of expression products. The first group of 16 mutants, which included the majority of the type I mutants, included K116Q, P131L, L139P, T183S, M193V, S194P, P211L, L215P, A245T, A245V, C270Y, E279K, V305R, V319M, M340-, and F365-, and yielded full-length fusion proteins that retained variable levels of NADH:cytochrome c reductase (NADH:CR) activity, ranging from approximately 2% (M340-) to 92% (K116Q) of that of the wild-type fusion protein. In contrast, the remaining nine mutants that represented the majority of the type II variants, comprised a second group that included Y109*, R124Q, Q143*, R150*, P162H, V172M, R226*, C270R, and R285*, and resulted in truncated H6NCR variants that retained the amino-terminal cytochrome b5 domain but were devoid of NADH:CR activity due to the absence of the cytochrome b5 reductase flavin domain. Kinetic analyses of the first group of full-length mutant fusion proteins indicated that values for both kcat and Km(NADH) were decreased and increased, respectively, indicating that the various mutations affected both substrate affinity and/or turnover. However, for the second group, the truncated products were the result of incomplete production of the carboxyl-terminal flavin-containing domain or instability of the expression products due to improper folding and/or lack of flavin incorporation.

Amino Acid Sequence↗

Methemoglobinemia induced by topical benzocaine: a warning for the endoscopist.

Benzocaine is used routinely for topical pharyngeal anesthesia prior to upper endoscopy, to improve patient tolerance. A potentially fatal, although often unrecognized, complication of benzocaine use is methemoglobinemia. Here, we report a case of methemoglobinemia induced by benzocaine given before upper endoscopy. Rapid recognition of this complication and immediate treatment is essential to prevent complications related to significant tissue hypoxia. This case serves as an important reminder to physicians, especially endoscopists, about this serious side effect. Furthermore, we question the need for topical anesthesia for upper endoscopy in sedated patients.

Aged↗

Hyperbaric oxygenation in the treatment of life-threatening isobutyl nitrite-induced methemoglobinemia--a case report.

Methemoglobinemia usually results from exposure to oxidizing substances such as nitrates or nitrites. Iron within hemoglobin is oxidized from the ferrous (Fe2+) state to the ferric (Fe3+) state, resulting in the inability to transport oxygen and carbon dioxide. Clinically, this condition causes functional cyanosis. As methemoglobin levels increase, patients show evidence of cellular hypoxia in all tissues. Death usually occurs when methemoglobin fractions approach 70% of total hemoglobin. We describe the case of a 35-year-old female patient with severe life-threatening isobutyl nitrite-induced methemoglobinemia of 75% of total hemoglobin. Toluidine-blue was administered as first-line antidotal therapy immediately, followed by hyperbaric oxygenation. The patient recovered uneventfully and could be discharged 3 days later.

Adult↗

Acute metobromuron poisoning with severe associated methemoglobinemia. Identification of four metabolites in plasma and urine by LC-DAD, LC-ESI-MS, and LC-ESI-MS-MS.

A case of self poisoning with metobromuron, a urea derivative used as a herbicide, is reported. Severe methemoglobinemia observed at the admission (80%) disappeared only at day 11, and hemolysis appeared at day 4 and decreased slowly to day 12. Metobromuron was analyzed by liquid chromatography with diode-array detection. Initial plasma concentration and elimination half-life were 4.9 mg/L and 5 h, respectively. Several metabolites were also detected, and four of those were identified by liquid chromatography-electrospray mass spectrometry. Normetobromuron, bromophenylurea, and bromoacetanilide were detected in plasma, but only N-methyl bromophenylurea was detected in urine. Bromoacetanilide probably results from acetylation of the intermediate bromoaniline. Methemoglobinemia could result from metabolization of metobromuron to bromoaniline and bromoacetanilide.

Acetanilides↗