Methemoglobinemia and hemolysis after enteral administration of methylene blue in a preterm infant: relevance for pediatric surgeons

Allegaert, Karel; Miserez, Marc; Lerut, Toni; Naulaers, Gunnar; Vanhole, C.; Devlieger, Hugo

doi:10.1016/j.jpedsurg.2003.09.045

Cited by 23 publications

(17 citation statements)

References 17 publications

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“…When used for methemoglobinemia, methylene blue is a reducing agent; however, it also may act as a potent oxidizing agent. Case reports of paradoxical methemoglobinemia caused by methylene blue exist; however, the majority of these reports are in infants who received high doses of methylene blue in a short period of time [20][21][22]. A review of 11 human clinical trials that used methylene blue for the treatment of septic shock did not reveal any cases of clinically significant methemoglobinemia when using methylene blue in doses comparable to those used in this case [23].…”

Section: Discussionmentioning

confidence: 72%

Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report

Laes

Williams

Cole³

2015

J. Med. Toxicol.

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Introduction The purpose of this study is to describe a case where methylene blue improved hemodynamics in a poisoned patient.Case Report This is a single case report where a poisoned patient developed vasodilatory shock following ingestion of atenolol, amlodipine, and valsartan. Shock persisted after multiple therapies including vasopressors, high-dose insulin, hemodialysis, and 20% intravenous fat emulsion. Methylene blue (2 mg/kg IV over 30 min) was administered in the ICU with temporal improvement as measured by pulmonary artery catheter hemodynamic data pre-and post-methylene blue administration. Within 1 h of methylene blue administration, systemic vascular resistance improved (240 dyn s/cm5 increased to 1204 dyn s/cm5), and vasopressor requirements decreased with maintenance of mean arterial pressure 60 mmHg. Discussion Methylene blue may improve hemodynamics in drug-induced vasodilatory shock and should be considered in critically ill patients poisoned with vasodilatory medications refractory to standard therapies.

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Section: Discussionmentioning

confidence: 72%

Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report

Laes

Williams

Cole³

2015

J. Med. Toxicol.

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“…The dye instead produced a blue coloring of the complete skin and all body fluids (Figure 2). Haemolysis, methemoglobinemia, neurological symptoms or other side effects which are described in literature were not observed [12].…”

Section: Patient Presentationmentioning

confidence: 80%

Cessation of severe chylothorax and chylous ascites in a newborn with trisomy 21 after whole blood pleurodesis: A case report

Rützel¹,

Gebauer²,

Pulzer³

et al. 2017

Pediatr Dimensions

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We present a case of a newborn with trisomy 21 and congenital lymphatic malformation leading to severe chylothorax and chylous ascites, which was successfully treated with autologous blood pleurodesis. Other established measures like adaptet enteral nutrition, parenteral nutrition, octreotide therapy and operative pleurodesis failed to decrease pleural fluid secretion beforehand.The second interesting aspect of this case is the fact, that intragastrally administered methylene blue resulted in a profound staining of the complete body. This is, to our knowledge, the fist surviving child of this constellation reported in the literature.

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“…Both forms undergo primarily urinary excretion with a half-life of approximately 4-5 hours [52]. Small amounts of MB are excreted in bile and feces as well [53]. Distribution appears to differ substantially between the two enteral and intravenous forms.…”

Section: Pharmacology Of Methylene Bluementioning

confidence: 99%

“…Once in the blood, MB readily enters erythrocytes where it is reduced to leucomethylene blue at low concentrations. In high concentrations it can act as an oxidizing agent, potentially leading to hemolysis, methemoglobinemia and hyperbilirubinemia [53]. Most side effects of MB appear to be dose-dependent and do not occur with doses below 2 mg/kg [55].…”

Section: Pharmacology Of Methylene Bluementioning

confidence: 99%

“…All five cases of encephalopathy occurred in female patients taking serotonin-metabolism modifying agents [58]. In the neonatal and pediatric populations, enteral MB administration of >2 mg/kg has been associated with severe methemoglobinemia, hemolytic anemia, Heinz body anemia, and hyperbilirubinemia [53]. Anemia following MB administration typically manifests within 24 hours, peaks at 4-5 days and can persist for up to 12 days [59].…”

Section: Pharmacology Of Methylene Bluementioning

confidence: 99%

See 1 more Smart Citation

Methylene Blue and Dialysis-Related Hypotension

Wisler¹,

Stawicki²

2011

Hemodialysis - Different Aspects

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Methemoglobinemia and hemolysis after enteral administration of methylene blue in a preterm infant: relevance for pediatric surgeons

Cited by 23 publications

References 17 publications

Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report

Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report

Cessation of severe chylothorax and chylous ascites in a newborn with trisomy 21 after whole blood pleurodesis: A case report

Methylene Blue and Dialysis-Related Hypotension

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