11/16. Fetal methemoglobinemia: a cause of nonimmune hydrops fetalis.A case of nonimmune hydrops fetalis resulting from fetal methemoglobinemia is presented. A woman with a pregnancy at 17 weeks' gestation was admitted after combustion gas intoxication. Although the mother totally recovered, the fetus showed signs of nonimmune hydrops fetalis at follow-up. Fetal methemoglobin levels were very high.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
12/16. dapsone intoxication: two case reports.Two patients with dapsone intoxication, an adult and a 16-month-old child, are reported. Both developed symptomatic methemoglobin concentrations, of 35% and 37%, respectively, and improved with intravenous methylene blue. Methemoglobin levels subsequently rose in both cases to 25% at 24 and 37 hours, respectively. The recurrence of elevated methemoglobin levels resulted from either continued absorption of dapsone or its toxic metabolite from the gastrointestinal tract. Both patients were begun on serial oral activated charcoal and the child received a second methylene blue treatment. During the intoxication, serum hemoglobin concentrations dropped 2 gm with an increase in the reticulocyte count. review of 20 cases of dapsone overdose from the literature showed that the major toxic manifestations are methemoglobinemia and hemolysis. Delayed sulfhemoglobinemia, reported in only one case, resolved spontaneously. The treatment of dapsone intoxication is intravenous methylene blue for symptomatic methemoglobinemia, gastric decontamination, and early administration of serial oral activated charcoal. hemolysis is mild but transfusions may be required for patients with a glucose-6-phosphate dehydrogenase deficiency.- - - - - - - - - - ranking = 7keywords = intoxication (Clic here for more details about this article) |
13/16. Acute sodium chlorite poisoning associated with renal failure.A 25-year-old Chinese male presented with generalized cyanosis and respiratory distress. The patient was known to have ingested 10 g of sodium chlorite in a suicide attempt. methemoglobinemia was found and intravenous methylene blue was given repeatedly. However, the therapy could not prevent an acute hemolytic crisis. methemoglobinemia remained profound (43.1%) and disseminated intravascular coagulation ensued. He was put on CAVHD to correct the fluid overload and probably to remove the active metabolites of the chlorite. After 24 h, the methemoglobin was reduced to 16.9%. However, the development of acute renal failure further complicated the clinical course. Percutaneous renal biopsy suggested a picture of acute tubulointerstitial nephropathy. In addition, hemodialysis was continued for 4 weeks. After 3 months, renal function normalized. To our knowledge, there has been no clinical report of human intoxication with sodium chlorite.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
14/16. methemoglobinemia due to skin application of benzocaine.We report a 2-year-old child who presented with severe methemoglobinemia after topical application of Lanacane (with 3% benzocaine). The experience with our patient shows that intoxication can occur in children if the drug is applied to a large area of skin that has lost its integrity. We discuss the usefulness of the pulse oximeter in making the diagnosis and review the management of methemoglobinemia.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
15/16. Combined dapsone and clofazimine intoxication.We report clinical findings and pharmacokinetic data regarding a combined dapsone and clofazimine intoxication in a man, who ingested 50 tablets of dapsone (100 mg) 20 capsules of clofazimine (100 mg) and two tablets of rifampicin (600 mg). Oral administration of activated charcoal (50 grams) and sodium sulphate (20 grams) after gastric lavage resulted in an elimination half-life in plasma of 11.1 and 10.8 h for dapsone and its main metabolite, monoacetyldapsone, respectively. A rapid initial decrease of the plasma concentration of clofazimine was observed after gastric lavage and administration of activated charcoal and sodium sulphate. 15 h after this treatment, clofazimine plasma levels remained relatively constant. dapsone-induced methaemoglobinaemia (48% at admission) was treated successfully with methylene blue.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
16/16. Acute dapsone intoxication: a pediatric case report.INTRODUCTION: There are many case reports of dapsone overdose in adults but only a few reports of dapsone-induced methemoglobinemia in children. We report a case of a three-year-old boy who developed prolonged recurrent methemoglobinemia following an ingestion of dapsone. methods: Case report. ethics: Not applicable. statistics: Not applicable. RESULTS: This child developed significant symptoms of methemoglobinemia approximately two hours after ingesting dapsone 37.5 mg/kg. The initial methemoglobin level measured 2.5 hours after ingestion was 44%. The patient was treated with multiple doses of activated charcoal and methylene blue. Three doses of methylene blue reduced the methemoglobin level to 6% by approximately 16 hours after the overdose but the level rebounded to nearly 15% at 64 hours postingestion. DISCUSSION: dapsone is a drug that is being used for a wide variety of clinical conditions. The primary clinical manifestation of dapsone overdose is methemoglobinemia. An important aspect of dapsone poisoning is its ability to produce methemoglobinemia, which is long lasting and which may recur following methylene blue therapy. Because of this, dapsone-poisoned children need to be monitored for two to three days.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
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