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Keats KR, Robinson R, Patel M, Wallace A, Albrecht S. Ascorbic Acid for Methemoglobinemia Treatment: A Case Report and Literature Review. J Pharm Pract 2024; 37:1015-1020. [PMID: 37421600 DOI: 10.1177/08971900231188834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Purpose: Ascorbic acid has been proposed as an alternative treatment for methemoglobinemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. However, its efficacy has never been compared to that of methylene blue given the inability of patients with G6PD deficiency to receive methylene blue. We present a case of methemoglobinemia treated with ascorbic acid in a patient without G6PD deficiency who had previously received methylene blue. Summary: A 66-year-old male was treated for methemoglobinemia deemed to be secondary to benzocaine throat spray. He received intravenous (IV) methylene blue but had a severe reaction: diaphoresis, lightheadedness, and hypotension. The infusion was stopped prior to completion. Approximately 6 days later he presented with methemoglobinemia following an additional overconsumption of benzocaine and was treated with ascorbic acid. In both instances his methemoglobin levels were >30% on arterial blood gas on admission and decreased to 6.5% and 7.8%, respectively, after administration of methylene blue and ascorbic acid. Conclusion: Ascorbic acid had a similar effect on decreasing the concentration of methemoglobin compared to methylene blue. Further research into use of ascorbic acid as a recommended agent for treatment of methemoglobinemia is warranted.
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Affiliation(s)
- Kelli R Keats
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | - Rachel Robinson
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | - Mallika Patel
- Department of Internal Medicine, Augusta University Medical Center, Augusta, GA, USA
| | - Alexis Wallace
- Department of Internal Medicine, Augusta University Medical Center, Augusta, GA, USA
| | - Stephanie Albrecht
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
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Al-Kuraishy HM, Al-Gareeb AI, Elekhnawy E, Alexiou A, Batiha GES. The Potential Effect of Dapsone on the Inflammatory Reactions in COVID-19: Staggering View. Comb Chem High Throughput Screen 2024; 27:674-678. [PMID: 36999691 DOI: 10.2174/1386207326666230331121735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 04/01/2023]
Abstract
Severe SARS-CoV-2 infection is linked with an overstated immune response with the succeeding release of pro-inflammatory cytokines and progression of the cytokine storm. In addition, severe SARS-CoV-2 infection is associated with the development of oxidative stress and coagulopathy. Dapsone (DPS) is a bacteriostatic antibiotic that has a potent anti-inflammatory effect. Thus, this mini-review aimed to elucidate the potential role of DPS in mitigating inflammatory disorders in COVID-19 patients. DPS inhibits neutrophil myeloperoxidase, inflammation, and neutrophil chemotaxis. Therefore, DPS could be effective against neutrophilia-induced complications in COVID-19. In addition, DPS could be effective in mitigating inflammatory and oxidative stress disorders by suppressing the expression of inflammatory signaling pathways and the generation of reactive oxygen species (ROS) correspondingly. In conclusion, DPS might be effective in the management of COVID-19 through the attenuation of inflammatory disorders. Therefore, preclinical and clinical studies are reasonable in this regard.
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Affiliation(s)
- Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, AL-Mustansiriyia University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, AL-Mustansiriyia University, Baghdad, Iraq
| | - Engy Elekhnawy
- Pharmaceutical Microbiology Department, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Athanasios Alexiou
- Department of Science and Engineering, Novel Global Community Educational Foundation, Hebersham, Australia
- AFNP Med Austria, Wien, Austria
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511, Egypt
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Al-kuraishy HM, Al-Gareeb AI, Kaushik A, Kujawska M, Batiha GES. Hemolytic anemia in COVID-19. Ann Hematol 2022; 101:1887-1895. [PMID: 35802164 PMCID: PMC9263052 DOI: 10.1007/s00277-022-04907-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/25/2022] [Indexed: 12/15/2022]
Abstract
COVID-19 is a global pandemic triggered by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 entry point involves the interaction with angiotensin-converting enzyme 2 (ACE2) receptor, CD147, and erythrocyte Band3 protein. Hemolytic anemia has been linked to COVID-19 through induction of autoimmune hemolytic anemia (AIHA) caused by the formation of autoantibodies (auto-Abs) or directly through CD147 or erythrocyte Band3 protein-mediated erythrocyte injury. Here, we aim to provide a comprehensive view of the potential mechanisms contributing to hemolytic anemia during the SARS-CoV-2 infection. Taken together, data discussed here highlight that SARS-CoV-2 infection may lead to hemolytic anemia directly through cytopathic injury or indirectly through induction of auto-Abs. Thus, as SARS-CoV-2-induced hemolytic anemia is increasingly associated with COVID-19, early detection and management of this condition may prevent the poor prognostic outcomes in COVID-19 patients. Moreover, since hemolytic exacerbations may occur upon medicines for COVID-19 treatment and anti-SARS-CoV-2 vaccination, continued monitoring for complications is also required. Given that, intelligent nanosystems offer tools for broad-spectrum testing and early diagnosis of the infection, even at point-of-care sites.
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Affiliation(s)
- Hayder M. Al-kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, M.B.Ch.B, FRCP, Baghdad, Iraq
| | - Ali I. Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, M.B.Ch.B, FRCP, Baghdad, Iraq
| | - Ajeet Kaushik
- NanoBioTech Laboratory, Department of Environmental Engineering, Florida Polytechnic University, Lakeland, FL 33805-8531 USA
| | - Małgorzata Kujawska
- Department of Toxicology, Faculty of Pharmacy, Poznan University of Medical Sciences, Dojazd 30, 60-631 Poznań, Poland
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511, Al Beheira, Egypt
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Tang ASO, Cheah KC, Leong TS, Chew LP. Methaemoglobinaemia in pregnancy: Real world experience in a single centre in Malaysia. PROCEEDINGS OF SINGAPORE HEALTHCARE 2022. [DOI: 10.1177/20101058221111575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The literature on methaemoglobinaemia in pregnancy is scarce, imposing clinical challenges to both obstetricians and haematologists. We report a total of nine pregnancies with methaemoglobinaemia treated in our centre. Their methaemoglobin levels, mode of delivery, pregnancy management and outcome were summarized.
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Affiliation(s)
- Andy Sing Ong Tang
- Haematology Unit, Department of Internal Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - Kok Choon Cheah
- Haematology Unit, Department of Internal Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - Tze Shin Leong
- Haematology Unit, Department of Internal Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - Lee Ping Chew
- Haematology Unit, Department of Internal Medicine, Sarawak General Hospital, Sarawak, Malaysia
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Tang ASO, Wong QY, Yeo ST, Ting IPL, Lee JTH, Fam TL, Chew LP, Chua HH, Muniandy P. Challenges in Managing a Lepromatous Leprosy Patient Complicated with Melioidosis Infection, Dapsone-Induced Methemoglobinemia, Hemolytic Anemia, and Lepra Reaction. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931655. [PMID: 34038399 PMCID: PMC8165492 DOI: 10.12659/ajcr.931655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patient: Female, 22-year-old Final Diagnosis: Lepromatous leprosy co-infected with melioidosis • complicated by dapsone-induced methaemoglobinaemia and type 2 lepra reaction Symptoms: Cyanosis • fever • jaundice • pallor • skin rash Medication: — Clinical Procedure: — Specialty: Dermatology • Hematology • Infectious Diseases • General and Internal Medicine • Microbiology and Virology
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Affiliation(s)
- Andy Sing Ong Tang
- Department of Internal Medicine, Miri General Hospital, Ministry of Health Malaysia, Miri, Sarawak, Malaysia
| | - Qi Ying Wong
- Department of Internal Medicine, Miri General Hospital, Ministry of Health Malaysia, Miri, Sarawak, Malaysia
| | - Siaw Tze Yeo
- Department of Internal Medicine, Miri General Hospital, Ministry of Health Malaysia, Miri, Sarawak, Malaysia
| | - Ingrid Pao Lin Ting
- Department of Internal Medicine, Miri General Hospital, Ministry of Health Malaysia, Miri, Sarawak, Malaysia
| | - Jenny Tung Hiong Lee
- Department of Pathology, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
| | - Tem Lom Fam
- Department of Internal Medicine, Miri General Hospital, Ministry of Health Malaysia, Miri, Sarawak, Malaysia
| | - Lee Ping Chew
- Haematology Unit, Department of Internal Medicine, Sarawak General Hospital, Sarawak, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
| | - Hock Hin Chua
- Infectious Disease Unit, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
| | - Pubalan Muniandy
- Dermatology Unit, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
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Sahu KK, Mishra AK. Role of ascorbic acid in dapsone induced methemoglobinemia. Clin Exp Emerg Med 2019; 6:91-92. [PMID: 30944294 PMCID: PMC6453690 DOI: 10.15441/ceem.18.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
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Abstract
Methemoglobin is formed when the iron center in hemoglobin is oxidized from ferrous iron to ferric iron. The functional consequence of this change is that hemoglobin is transformed to methemoglobin and cannot oxygenate tissues adequately, causing hypoxia and cyanosis. Infants have unique physiology that increases their risk of developing methemoglobinemia. Infants drink more water per body weight compared to children and adults, have lower NADH cyb5r reductase activity that converts methemoglobin to hemoglobin, and have a higher percentage of fetal hemoglobin, which is easier to convert to methemoglobin. A well-studied exposure to a chemical that can cause methemoglobinemia in infants is nitrate in well water. For the first part specifically about methemoglobin in infants, articles that were recent (2015-now) were given preference over articles that were older. Search terms included: methemoglobin, methemoglobinemia, infant, acquired, congenital, and methylene blue. For the latter half of the paper on nitrate and methemoglobinemia, preference was given to articles that described regionally important cases. In addition, search terms were: Minnesota, methemoglobinemia, nitrate, well water, drinking water, and infant. Acquired methemoglobinemia is rare, yet can still be seen in medical settings, and when an infant is exposed to nitrate in well water above 10 mg/L. To prevent exposure, parents should have their water tested for nitrate before the baby comes home. Physicians should make it practice to ask what the source of drinking water is for newly pregnant women and urge them to test for nitrate and bacteria if using a well. Using bottled water to make formula is also an option, but the best option is still breastfeeding.
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