Cases reported "Methemoglobinemia"

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1/16. dapsone-induced methemoglobinemia and hemolytic anemia.

    The treatment of two common adverse effects of dapsone (methemoglobinemia and hemolytic anemia) is discussed, and a case of acute dapsone intoxication is described. A pregnant 29-year-old woman was admitted to an emergency room three hours after ingesting 50 tablets of dapsone (100 mg each) and six alcoholic drinks. One hour after admission 50 g of activated charcoal was given p.o., and 65 mg of methylene blue was given i.v. The patient was found to have a methemoglobin concentration of 25.1%. Arterial blood gases while the patient was breathing 4 L/min of oxygen by nasal cannula were PO2, 136 mm Hg (72.1% saturation); PCO2, 28.9 mm Hg; bicarbonate content, 18.9 mmol/L; and pH, 7.42. oxygen therapy was changed to 100% oxygen by face mask, 50 g of activated charcoal in sorbitol was administered p.o., and another 65 mg of methylene blue was given i.v. Two more 50-g doses of activated charcoal in sorbitol were given (18.5 and 22 hours after dapsone ingestion). methylene blue 130 mg was given 14 hours after dapsone ingestion, and 65 mg was given 21, 36, and 55.5 hours after ingestion. Methemoglobin concentrations never rose above 20% after the sixth dose of methylene blue. On hospital days 2 and 3, laboratory values were consistent with a diagnosis of hemolytic anemia; the patient received two units of packed red blood cells. The hematocrit decreased over the next three days to 23.9%, and the patient received four units of packed red blood cells.(ABSTRACT TRUNCATED AT 250 WORDS)
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2/16. Celecoxib-induced methemoglobinemia.

    OBJECTIVE: To report a case of acute methemoglobinemia in a patient treated with celecoxib for osteoarthritis. CASE SUMMARY: A 72-year-old African American man developed an acute confusional state (ACS) one month after receiving celecoxib for osteoarthritis of his knee joints. There was no other identifiable cause of ACS such as any recognized cause of metabolic encephalopathy, meningoencephalitis, cerebrovascular accident, or drug intoxication. He was found to have severe methemoglobinemia (serum methemoglobin fraction 9%; reference range 0-0.2). His symptoms improved substantially, and serum methemoglobin levels decreased to 0.7% after the initiation of methylene blue therapy. He was discharged on oral riboflavin and ascorbic acid and was advised not to restart celecoxib therapy. He had not shown any recurrence of the symptoms at a follow-up visit 2 months after the withdrawal of celecoxib. DISCUSSION: Celecoxib is a nonsteroidal antiinflammatory drug that selectively inhibits cyclooxygenase-2. Acute methemoglobinemia can present as a syndrome of nonspecific symptoms such as headache, nausea, fatigue, dyspnea, and lethargy; these may progress to respiratory depression, coma, shock, seizures, and death. Although acute methemoglobinemia has been reported with the use of several drugs, including sulfonamides, as of August 13, 2004, this is the first case report of severe methemoglobinemia manifesting as ACS with celecoxib therapy. Use of the Naranjo probability scale indicated a probable relationship between the clinical manifestations of methemoglobinemia and celecoxib therapy in this patient. CONCLUSIONS: Celecoxib can be associated with acute methemoglobinemia. Prompt diagnosis of this condition, withdrawal of celecoxib, and treatment with the antagonists (methylene blue, ascorbic acid, riboflavin) can reverse this potentially serious condition.
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3/16. Acute renal failure following ingestion of manganese-containing fertilizer.

    fertilizers are used to promote the survival and growth of plants and crops and have a good safety record when used properly. The basic elements in fertilizer include phosphorus, nitrite, and potassium. In addition, there are additive agents that vary for different crops and which may include some metals. Acute intoxication by ingesting fertilizer includes damage to various organ systems as well as severe cardiovascular or respiratory distress. We report the case of a 64-year-old man who ingested about 700 mL of fertilizer and suffered acute renal failure, hyperkalemia, and mild methemoglobinemia. After supportive care and emergent hemodialysis for hemodynamic instability due to hyperkalemia, the renal function of the patient recovered in four days.
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4/16. Excessive methaemoglobinaemia and multi-organ failure following 4-DMAP antidote therapy.

    This report describes the clinical history of a patient intoxicated with methyl isocyanate (MIC), a toxic agent first receiving attention in 1984 after a mass accident in a pesticide plant in Bhopal, india, and treated with the cyanide-specific antidote 4-DMAP. The numerous clinical conditions requiring 39-day intensive care treatment included ARDS, renal and hepatic failure, haemolysis, bone marrow depression, septic encephalopathy and critical illness polyneuropathy. The most outstanding condition, however, was a methaemoglobinemia of 86.7%, which was predominantly related to the use of 4-DMAP, although uptake of MIC may have been a significant contributing factor. Since significant cyanide intoxication could be excluded clinically and by laboratory testing in the initial phase of emergency treatment, most of the clinical effects were due to the side-effects of the antidote therapy. Due to intensive therapy, the patient survived without any neurological or organ deficit. This case shows that antidotes should be used cautiously in cases where uncertainties about the nature of the underlying toxic agent exist. This may prevent severe side-effects associated with antidote therapy, e.g. 4-DMAP, if there is-as in our case-a mismatch between the toxic agent and the antidote.
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5/16. Severe methemoglobinemia due to food intoxication in infants.

    The purpose of this case report is to illustrate food intoxication in infants as a consequence of fennel ingestion. Four cases of methemoglobinemia (MetHb) are presented here. Each patient ate homemade fennel puree a few hours prior to arriving to the emergency department with cyanosis unresponsive to oxygen, in the absence of suspected cyanotic heart disease. All 4 patients received treatment with methylene blue and fully recovered. Our cases emphasize that improper handling and storing of vegetables can lead to life-threatening MetHb.
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6/16. Continuing importance of nitrate contamination of groundwater and wells in rural areas.

    The contamination of groundwater and rural drinking water supplies by nitrates from livestock and human excrement, other organic waste, or chemical fertilizers is a potential hazard throughout the world. Infant illness and death from nitrate-induced methemoglobinemia is probably often misdiagnosed, perhaps as sudden infant death syndrome, and certainly contributes to the national infant death rate statistics. A 1950 report listed 144 cases of infant methemoglobinemia with 14 deaths in one 30-month period in minnesota. Infant deaths resulting from misdiagnosis of this preventable, treatable intoxication were still occurring as recently as 1986 in south dakota. In this state, about 39% of dug or bored wells were unsafe due to high nitrate content, compared with 22% of drilled wells and 16% of driven wells. Properly constructed wells more than 30 m deep are more likely to be safe. groundwater concentrations of nitrate may be unsafe for consumption, and standards are needed to regulate such contamination. Such standards could serve as guidelines and could be enforceable in the case of water systems dependent on wells.
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7/16. Recurrent methemoglobinemia after acute dapsone intoxication in a child.

    dapsone is a synthetic sulfone increasingly used in the treatment of a wide variety of dermatologic disorders. The case of a child with dapsone-induced recurrent methemoglobinemia is presented with a discussion of dapsone toxicity and its treatment. In addition, the diagnostic value of pulse oximetry in the presence of dysfunctional hemoglobins is discussed.
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keywords = intoxication
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8/16. methemoglobinemia resulting from absorption of nitrates.

    Three cases of toxic methemoglobinemia resulted from absorption of nitrate salts through burned skin areas. In addition to the unusual route of intoxication, this report emphasizes the occupational hazard of methemoglobinemia in workers exposed to nitrogen salts and the importance of rapid diagnosis and treatment. The diagnosis of methemoglobinemia should be suspected in any case of cyanosis refractory to oxygen therapy. Appropriate treatment should include oxygen, methylene blue, and exchange transfusion in clinically severe cases.
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9/16. Delayed sulfhemoglobinemia after acute dapsone intoxication.

    A case of acute dapsone intoxication due to voluntary ingestion of 3 g of this drug as a suicide attempt is described. A severe methemoglobinemia developed, accompanied by intense cyanosis, dyspnea, headache, and nausea. Subsequently, significant sulfhemoglobinemia responsible for prolonged cyanosis was observed, as well as mild hemolytic anemia. Relapses of methemoglobinemia after methylene blue treatment required repeated administration of the reducing agent. The need of a careful follow-up for several days in this type of intoxication is emphasized.
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10/16. Severe accidental dapsone overdose.

    Acute poisoning from excessive dapsone (4,4-diaminodiphenylsulfone) intake in uncommon in the united states; no cases were reported during 1992. However, with the increasing use of dapsone for diseases other than leprosy and dermatitis herpetiformis, such as acne vulgaris, psoriasis, and pneumocystis carinii pneumonia infection in acquired immunodeficiency syndrome, clinicians should be aware of potential toxicities. This report describes a case of accidental dapsone intoxication resulting in severe cyanosis with a modest elevation in methemoglobin concentration.
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