Acute life-threatening methaemoglobinaemia following ingestion of chloroquine

Rizvi, Imran; Zaman, Shamsuz; Zaidi, Noorin; S, Mohammed Asif; Abdali, Nasar

doi:10.1136/bcr.12.2011.5383

Cited by 15 publications

(8 citation statements)

References 8 publications

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“…Carboxyhemoglobinemia, which leads to overestimates of the arterial oxygen saturation, could conceivably be seen in individuals with heavy tobacco use or who are using gas grills or heaters in enclosed spaces. Methemoglobin is less likely to be seen in the general population, although some drugs, including chloroquine ( 21 ) and antibacterial sulfonamides like dapsone ( 22 ), can be problematic. However, the typical values measured by these devices when methemoglobin levels become clinically important always fall below <90% and would fortunately lead patients to present to care by any reasonable threshold of apparent developing hypoxemia.…”

Section: Sources Of Error In Pulse Oximetry Monitoringmentioning

confidence: 99%

Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance

2020

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During the ongoing coronavirus disease (COVID-19) pandemic, reports in social media and the lay press indicate that a subset of patients are presenting with severe hypoxemia in the absence of dyspnea, a problem unofficially referred to as “silent hypoxemia.” To decrease the risk of complications in such patients, one proposed solution has been to have those diagnosed with COVID-19 but not sick enough to warrant admission monitor their arterial oxygenation by pulse oximetry at home and present for care when they show evidence of hypoxemia. Though the ease of use and low cost of pulse oximetry makes this an attractive option for identifying problems at an early stage, there are important considerations with pulse oximetry about which patients and providers may not be aware that can interfere with successful implementation of such monitoring programs. Only a few independent studies have examined the performance of pocket oximeters and smart phone–based systems, but the limited available data raise questions about their accuracy, particularly as saturation falls below 90%. There are also multiple sources of error in pulse oximetry that must be accounted for, including rapid fluctuations in measurements when the arterial oxygen pressure/tension falls on the steep portion of the dissociation curve, data acquisition problems when pulsatile blood flow is diminished, accuracy in the setting of severe hypoxemia, dyshemoglobinemias, and other problems. Recognition of these issues and careful counseling of patients about the proper means for measuring their oxygen saturation and when to seek assistance can help ensure successful implementation of needed monitoring programs.

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Section: Sources Of Error In Pulse Oximetry Monitoringmentioning

confidence: 99%

Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance

2020

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“…Methaemoglobinaemia should be suspected based on the clinical history, physical examination and on discrepancy between the oxygen saturation obtained by routine pulse oximetry and the oxygen saturation calculated from arterial blood gas analysis—‘saturation gap’ 2 3. In this case, a thorough physical examination raised the suspicion of methaemoglobinaemia and the patient was treated accordingly in a short time frame despite the fact that the partial pressure of arterial oxygen (PaO 2 ) could not be determined, as previously mentioned.…”

Section: Discussionmentioning

confidence: 95%

The painted shoes

2015

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SUMMARYA previously well 4-year-old boy presented to the emergency room with progressive cyanosis, pallor and vomiting over the last 5 h. Oxygen saturation on pulse oximetry was 87-89% despite 9 L/min of supplemental oxygen. He was tachypnoeic and had a systolic heart murmur, with no other findings on clinical examination. In his medical history, there was record of a restrictive atrial septal defect, with a normal echocardiogram from 3 years before. He had no relevant family history. His shoes appeared to have been recently painted, which raised the suspicion of methaemoglobinaemia, presumptively caused by aniline-containing shoe dye. The shoes were removed promptly and his feet washed profusely. After confirming the diagnosis, methylene blue was started. The level of methaemoglobin decreased rapidly and the boy made a full recovery. BACKGROUND

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“…Trials have demonstrated some benefits for use in sepsis in critical care settings,11 although the largest dedicated trial for its use in sepsis (SMURF trial) was recently withdrawn prior to enrolment 12. Methylene blue is used in the treatment of methaemaglobinaemia and overdose of other agents through different mechanisms 13. There are also early experimental data to suggest that it may be a potential neuroprotective agent 14…”

Section: Discussionmentioning

confidence: 99%

Feeling blue with metformin-associated lactic acidosis

Plumb¹,

Parker

Wong

2013

BMJ Case Reports

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An active 66-year-old diabetic woman presented with a 5-day history of vomiting and abdominal pain, refractory shock and acute kidney injury (AKI). There was concomitant ACE inhibitor (ACEi) use and metformin toxicity with severe lactic acidosis. She suffered a pulseless electrical activity (PEA) cardiac arrest within 30 min of arrival to the Medical Admissions Unit. Despite a serum pH of 6.57 she was successfully resuscitated. She remained haemodynamically unstable even with fluid resuscitation, inotropic support and haemodiafiltration, yet made a full and rapid recovery following the introduction of a methylene blue infusion.

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Acute life-threatening methaemoglobinaemia following ingestion of chloroquine

Cited by 15 publications

References 8 publications

Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance

Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance

The painted shoes

Feeling blue with metformin-associated lactic acidosis

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