1
|
Rathod BD, Kamble N, Awadhiya O, Narang U, Khot RS, Kumbhalkar S. Shades of Blue: A Case Series of Acquired Methemoglobinemia. Cureus 2024; 16:e58312. [PMID: 38752026 PMCID: PMC11095280 DOI: 10.7759/cureus.58312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Acquired methemoglobinemia (MetHb) is a rare but potentially life-threatening condition that has varied etiology, usually toxin- or drug-induced. We had five cases of acquired methemoglobinemia during six months. Their presentation varied from an asymptomatic state to respiratory distress. The presence of cyanosis and low oxygen saturation (SpO2), despite normal partial pressure of oxygen (PaO2) and chocolate brown-colored blood, were diagnostic clues present in all cases. A high level of methemoglobinemia was detected on arterial blood gas (ABG), confirming the diagnosis. Methylene blue was used as an antidote along with supportive care in symptomatic cases. All these cases of methemoglobinemia recovered completely. A high index of suspicion for methemoglobinemia should be maintained in cases presenting with persistent hypoxia or cyanosis despite normal PaO2.
Collapse
Affiliation(s)
| | - Nilesh Kamble
- General Medicine, All India Institute of Medical Sciences, Nagpur, IND
| | - Onkar Awadhiya
- General Medicine, All India Institute of Medical Sciences, Nagpur, IND
| | - Udit Narang
- General Medicine, All India Institute of Medical Sciences, Nagpur, IND
| | - Rajashree S Khot
- General Medicine, All India Institute of Medical Sciences, Nagpur, IND
| | - Sunita Kumbhalkar
- General Medicine, All India Institute of Medical Sciences, Nagpur, IND
| |
Collapse
|
2
|
El Hamzaoui H, Chajai I, El Ouazzani MC, Benhalima A, El Arfaoui M, Alilou M. Acute dapsone poisoning with methemoglobinemia: a case report. Pan Afr Med J 2022; 43:20. [PMID: 36451721 PMCID: PMC9674526 DOI: 10.11604/pamj.2022.43.20.34069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2023] Open
Abstract
Methemoglobinemia is a common complication of dapsone poisoning. Its´ treatment usually relies on methylene blue infusion. The aim of this study was to report a case of an acute dapsone poisoning with methemoglobinemia treated only with ascorbic acid and activated charcoal. A 16-year-old female voluntary ingested 3 grams of dapsone in an attempt of suicide and presented with desaturation and tachypnea. Lab findings were compatible with methemoglobinemia. After two days of treatment with ascorbic acid and activated charcoal, we observed the disappearance of desaturation and tachypnea. Methemoglobinemia can be treated with ascorbic acid and activated charcoal in limited resource settings.
Collapse
Affiliation(s)
- Hamza El Hamzaoui
- Emergency Department, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V of Rabat, CHU Ibn Sina, Rabat, Morocco
| | - Idriss Chajai
- Emergency Department, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V of Rabat, CHU Ibn Sina, Rabat, Morocco
| | - Mohamed Chahidi El Ouazzani
- Emergency Department, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V of Rabat, CHU Ibn Sina, Rabat, Morocco
| | - Abdelkader Benhalima
- Emergency Department, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V of Rabat, CHU Ibn Sina, Rabat, Morocco
| | - Manal El Arfaoui
- Emergency Department, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V of Rabat, CHU Ibn Sina, Rabat, Morocco
| | - Mustapha Alilou
- Emergency Department, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V of Rabat, CHU Ibn Sina, Rabat, Morocco
| |
Collapse
|
3
|
Tripathi T, Singh AR, Kapoor R, Sinha A, Ghosh S, Kaur K, Pokhariya D, Maity S, Tapadar A, Chandra A. Dapsone-induced methaemoglobinaemia in leprosy: a close mimic of 'happy hypoxia' in the COVID-19 pandemic. J Eur Acad Dermatol Venereol 2021; 35:e568-e571. [PMID: 34037283 PMCID: PMC8242520 DOI: 10.1111/jdv.17394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T Tripathi
- Department of Dermatology, Base Hospital Barrackpore, Kolkata, India
| | - A R Singh
- Department of Medicine, Base Hospital Barrackpore, Kolkata, India
| | - R Kapoor
- Departments of Medicine and Haematology, Command Hospital Eastern Command, Kolkata, India
| | - A Sinha
- Department of Dermatology, Military Hospital Kirkee, Pune, India
| | - S Ghosh
- Department of Medicine, Base Hospital Barrackpore, Kolkata, India
| | - K Kaur
- Department of Pathology, Base Hospital Barrackpore, Kolkata, India
| | - D Pokhariya
- Department of Radiology, Base Hospital Barrackpore, Kolkata, India
| | - S Maity
- Department of Anaesthesiology and Critical Care, Base Hospital Barrackpore, Kolkata, India
| | - A Tapadar
- Department of Medicine, Base Hospital Barrackpore, Kolkata, India
| | - A Chandra
- Department of Medicine, Base Hospital Barrackpore, Kolkata, India
| |
Collapse
|
4
|
Tang C, Long R, Tong X, Guo Y, Tong C, Shi S. Dual-emission biomass carbon dots for near-infrared ratiometric fluorescence determination and imaging of ascorbic acid. Microchem J 2021. [DOI: 10.1016/j.microc.2021.106000] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
5
|
Sahu KK, Mishra AK, Lal A, Siddiqui AD, George SV. Cocaine-induced methemoglobinemia. World J Emerg Med 2021; 12:81-82. [PMID: 33505557 PMCID: PMC7790706 DOI: 10.5847/wjem.j.1920-8642.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/12/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | - Amos Lal
- MD Medicine, Mayo Clinic, Rochester 55905, USA
| | | | | |
Collapse
|
6
|
Minnelli N, Gibbs L, Larrivee J, Sahu KK. Challenges of Maintaining Optimal Nutrition Status in COVID-19 Patients in Intensive Care Settings. JPEN J Parenter Enteral Nutr 2020; 44:1439-1446. [PMID: 32799322 PMCID: PMC7461277 DOI: 10.1002/jpen.1996] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/07/2020] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has threatened patients, healthcare systems, and all countries across the globe with unprecedented challenges and uncertainties. According to the latest literature, most patients with COVID-19 have mild symptoms that do not require hospital admissions, and only a small percentage of those hospitalized require intensive care. In the intensive care unit (ICU), a registered dietitian nutritionist (RDN) assists the critical care team by formulating, executing, and monitoring the nutrition strategies and interventions to meet the unique requirements of extremely sick patients. However, because of the novelty of COVID-19, the situation is fluid and guidelines continue to be developed and updated. This article discusses the interim guidelines available for the nutrition support of ICU COVID-19 patients and the challenges the critical care team and RDN may face from a nutrition standpoint.
Collapse
Affiliation(s)
- Nicole Minnelli
- Department of Food and NutritionMorrison HealthcareSaint Vincent HospitalWorcesterMassachusettsUSA
| | - Lisa Gibbs
- Department of Food and NutritionMorrison HealthcareSaint Vincent HospitalWorcesterMassachusettsUSA
| | - Jennifer Larrivee
- Department of Food and NutritionMorrison HealthcareSaint Vincent HospitalWorcesterMassachusettsUSA
| | - Kamal Kant Sahu
- Department of Internal MedicineSaint Vincent HospitalWorcesterMassachusettsUSA
| |
Collapse
|
7
|
Sahu KK, Mishra AK, Lal A, George SV, Siddiqui AD. Closing the saturation gap: a ten-year retrospective experience with methemoglobinemia. Intern Emerg Med 2020; 15:1109-1112. [PMID: 32277338 DOI: 10.1007/s11739-020-02332-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA.
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA
| | - Amos Lal
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Susan V George
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA
| | - Ahmad Daniyal Siddiqui
- Division of Hematology and Medical Oncology, Saint Vincent Cancer and Wellness Center, 1 Eaton Place, Worcester, MA, 01608, USA
| |
Collapse
|
8
|
Sahu KK, Mishra AK, Lal A, George SV. Acetaminophen induced methemoglobinemia. Clin Toxicol (Phila) 2020; 58:784-785. [PMID: 31621426 DOI: 10.1080/15563650.2019.1677909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Kamal Kant Sahu
- MD Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, 01608, MA, USA
| | | | - Amos Lal
- MD Medicine, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
9
|
Sahu KK, George SV, Siddiqui AD. Systematic Review of Methemoglobinemia in Acetaminophen Poisoning. QJM 2020; 115:hcaa174. [PMID: 32428237 DOI: 10.1093/qjmed/hcaa174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/29/2020] [Accepted: 05/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acetaminophen (N-acetyl-para-aminophenol, paracetamol, (APAP) toxicity is one of the commonly encountered poisonings by emergency physicians. Methemoglobinemia is an uncommon association and rarely seen in APAP poisoning. METHODS Retrospective analysis of all the published reports on APAP induced methemoglobinemia from 1968 to 2019. RESULTS In total there were 14 cases with 9 females and 6 males. The median age of the study cohort was 59 years. The most common presenting feature was altered mentation (9 patients) followed by cyanosis (3 patients). The intent of consumption was therapeutic (7 cases) versus suicidal (5 cases) attempt.In most cases, the dose of APAP consumption was not known. Aspirin, sulfasalazine, benzocaine spray, nitrate preservative, contaminated water, detergents, etc. where the other agents consumed by the patients in addition to APAP before developing methemoglobinemia. The median MethHb level of the study cohort was 15.85% Patients were treated with NAC, hemodialysis, methylene blue, and ascorbic acid and CRRT in various combinations. Full recovery was seen in 9 patients while 4 patients died. CONCLUSION APAP toxicity is a well-known and common entity with multiple sequelae that presents with a variable spectrum of mild to fulminant multiorgan failure. Awareness of non-classical presentations like methemoglobinemia is essential to ensure timely intervention.
Collapse
Affiliation(s)
- Kamal Kant Sahu
- Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts, United States
| | - Susan V George
- Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts, United States
| | - Ahmad Daniyal Siddiqui
- Hematology and Oncology division, Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, United States
| |
Collapse
|
10
|
Sahu KK, Brown R, Mishra AK, Lal A, George SV. Topical agents causing methemoglobinemia. Am J Emerg Med 2020; 38:1041-1042. [PMID: 31859195 DOI: 10.1016/j.ajem.2019.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/13/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester 01608, MA, United States.
| | - Regina Brown
- Department of Internal Medicine, Saint Vincent Hospital, Worcester 01608, MA, United States
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester 01608, MA, United States
| | - Amos Lal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester 01608, MA, United States
| | - Susan V George
- Department of Internal Medicine, Saint Vincent Hospital, Worcester 01608, MA, United States
| |
Collapse
|
11
|
Sahu KK, Lal A, Mishra A, George S. Food poisoning associated methemoglobinemia: Time to wake up. World J Emerg Med 2020; 11:127-128. [PMID: 32076482 PMCID: PMC7010525 DOI: 10.5847/wjem.j.1920-8642.2020.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts 01608, USA
| | - Amos Lal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts 01608, USA
| | - Ajay Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts 01608, USA
| | - Susan George
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts 01608, USA
| |
Collapse
|
12
|
Sahu KK, Lal A, Kumar Mishra A, Sahu SA. E-Cigarettes and Methemoglobinemia: A Wolf in Sheep's Clothing. Am J Med 2019; 132:e759. [PMID: 31358288 DOI: 10.1016/j.amjmed.2019.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, 01608, Massachusetts, United States.
| | - Amos Lal
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, 01608, Massachusetts, United States
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, 01608, Massachusetts, United States
| | - Shamendra Anand Sahu
- Department of Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, Raipur, 492099, Chhattisgarh, India
| |
Collapse
|