Methemoglobinemia Caused by Portable Dialysis in the Critically Ill

Medarov, Boris I.; Pahwa, Suneet; Reed, Stephanie S; Blinkhorn, Richard; Rane, Neha; Judson, Marc A.

doi:10.1097/ccm.0000000000002062

Cited by 6 publications

(9 citation statements)

References 8 publications

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“…U ambulantních pacientů na domácí dialýze byla příčinou kontaminace vody v domácím zdroji, nejčastěji ve studni (11). U hospitalizovaných pacientů na kontinuální náhradě funkce ledvin byla jako příčina identifikována neadekvátní clearance chloraminu z vodovodního řadu (12,13). Řešením byla v obou případech výměna filtru.…”

Section: Hemodialýza a Methemoglobinemieunclassified

Hospital-acquired methemoglobinemia

Táborský¹,

Střelka²,

Káňová³

et al. 2020

Vnitř Lék

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a. s. 2 Klinika anesteziologie, resuscitace a intenzivní medicíny LF OU a FN Ostrava 3 Klinika hematoonkologie LF OU a FN Ostrava Methemoglobinemie je vzácná porucha hemového železa, při které jsou atomy dvojmocného železa oxidovány na železo trojmocné. Trojmocné železo váže kyslík s daleko vyšší afinitou (posun disociační křivky doleva) a hemoglobin ztrácí svoji schopnost transportovat kyslík do tkání. V článku je prezentována kazuistika pacientky s methemoglobinemií nejasné příčiny, která se rozvinula za hospitalizace na JIP. Dále jsou v textu prezentovány možné příčiny methemoglobinemie a terapeutické možnosti tohoto život ohrožujícího stavu.Klíčová slova: kyselina askorbová, lokální anestetika, methemoglobinemie, metylenová modř. Hospital-acquired methemoglobinemiaMethemoglobinemia is rare condition of hem iron. Ferrous form iron (Fe 2+ ) is oxidised to Ferric form (Fe 3+ ). Methemoglobin has reduced ability to release oxygen to tissues and thereby leads to tissue hypoxia. We present case of patient with methemoglobinemia of unknown etiology. Methemoglobinemia developed during hospitalization. Diferent causes of methemoglobinemia and also a treatment possibilities are discussed.

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Section: Hemodialýza a Methemoglobinemieunclassified

Hospital-acquired methemoglobinemia

Táborský¹,

Střelka²,

Káňová³

et al. 2020

Vnitř Lék

View full text Add to dashboard Cite

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“…These compounds modify cellular proteins and lipids, denature proteins, reduce red blood cell half‐life and render red blood cell membranes fragile and prone to haemolysis . Impaired clearance of chloramine with the use of portable dialysis machines have been associated with Methaemoglobinaemia in critical care patients undergoing haemodialysis . Uraemia, associated with end stage renal failure, reduces the ability to withstand oxidative stress imposed by chloramine exposure resulting in higher risk of haemolysis …”

Section: Causesmentioning

confidence: 99%

“…The most effective approach to removal is adsorption via filtration through activated charcoal columns (granular activated carbon) in the water treatment systems . Exhausted carbon filter systems have been identified in many outbreaks and isolated cases of haemolysis during haemodialysis . Current guidelines recommend the use of durable carbon filters (granular activated carbon or catalytic carbon) with high adsorption ratings and ability to withstand high flow rates.…”

Section: Causesmentioning

confidence: 99%

“…22,26 Impaired clearance of chloramine with the use of portable dialysis machines have been associated with Methaemoglobinaemia in critical care patients undergoing haemodialysis. 29,30 Uraemia, associated with end stage renal failure, reduces the ability to withstand oxidative stress imposed by chloramine exposure resulting in higher risk of haemolysis. 21 The most common cause of erythropoietin hyporesponsiveness is iron deficiency, however chronic haemolysis can also manifest as erythropoietin resistance.…”

Section: Chemical Contamination -Chloraminementioning

confidence: 99%

“…27,34 Exhausted carbon filter systems have been identified in many outbreaks and isolated cases of haemolysis during haemodialysis. 23,29,30 Current guidelines recommend the use of durable carbon filters (granular activated carbon or catalytic carbon) with high adsorption ratings and ability to withstand high flow rates. Dialysis units are required to have two carbon filters, connected in series.…”

Section: Chemical Contamination -Chloraminementioning

confidence: 99%

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Haemolysis in haemodialysis

Tharmaraj

Kerr

2017

Nephrology

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ABSTRACT:Haemolysis in haemodialysis, although rare in current times, is associated with significant mortality and morbidity. As such prompt recognition, treatment, analysis of root cause and correction of underlying causative factors is crucial. Dialysate, extracorporeal circuit and patient related factors all contribute to haemolysis risk. Haemolysis can manifest with non-specific signs and symptoms including but not restricted to hypertension, nausea, pain (abdominal, chest, back) and dyspnoea. It may present acutely during the dialysis session or may take a protracted course. Potential life threating consequences include; hyperkalaemia induced cardiac arrhythmias, profound anaemia and associated acute coronary events and respiratory distress, and severe necrotizing pancreatitis. Chronic haemolysis results in impaired endothelial function thus contributing to the long-term cardiovascular risk profile in haemodialysis patients. Stringent national and international standards, technological advancements in membrane and dialysis equipment design, dialyser purification methods and water treatment systems have greatly reduced the incidence of haemolysis. Despite these improvements recognition of haemolysis risk and ongoing clinical vigilance is important.

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