Severe hypoxaemia due to methaemoglobinaemia and aspiration pneumonia.

The authors report a case of a previously healthy 40-year-old man who was admitted to the emergency department due to severe hypoxaemia after emesis. He vomited after a cup of coffee with the milk at his office. On admission, he showed cyanosis and oxygen saturation measured by pulse oximetry was extremely low (86%) in spite of the administration of 10 litres of oxygen. The authors suspected pneumonia, but oxygen saturation was disproportionately low to pneumonia severity. Oxygen saturation measured by pulse oximetry was significantly different from oxygen saturation calculated from arterial blood gas analysis, suggesting the existence of haemoglobin abnormality. The level of methaemoglobin was 9.3% (reference range, 1-2%). The patient was treated by antibiotics for pneumonia, and his methaemoglobinaemia was spontaneously ameliorated. The authors later found that the patient drank bleach containing hypochlorous acid instead of milk by mistake. To conclude, the patient's hypoxaemia was due to pneumonia and drug-induced acquired methaemoglobinaemia.

A novel sensor to estimate the prevalence of hypochlorous (HOCl) toxicity in individuals with type 2 diabetes and dyslipidemia.

BACKGROUND: Oxidative stress is common in type 2 diabetes. It is characterised by increased levels of reactive oxygen species (ROS), of which hypochlorous acid (HOCl) is an important component. Type 2 diabetes is characterised not only by hyperglycemia, but also by dyslipidemia. It probably underlies both the development of diabetes and also resulting complications, like cardiovascular disease. We applied a novel fluoroprobe RHQ to estimate endogenous HOCl and myeloperoxidase (MPO) activity in diabetes and dyslipidemia. METHODS: Our newly designed probe, RHQ (rhodamine-quinoline based chemodosimeter) is capable of estimating endogenous HOCl selectively out of the ROS components. Isolated leukocytes from study subjects were treated with DCFDA and monocytes and neutrophils with RHQ for estimating endogenous ROS and HOCl respectively. Plasma AOPP, an indicator of HOCl was also measured. We attempted to find out the key reasons of higher HOCl content in diabetic dyslipidemic subjects by quantitating endogenous hydrogen peroxide (H2O2) and myeloperoxidase (MPO) activity. RESULTS: Isolated PBMCs from diabetic dyslipidemic subjects indicated enhanced ROS and HOCl generation followed by diabetic subjects without dyslipidemia and healthy controls. We explored increased production of H2O2 and enhanced enzymatic activity of myeloperoxidase (MPO) among diabetic dyslipidemic subjects (p<0.0001) resulting in higher HOCl content. CONCLUSION: The hyperglycemic and hyperlipidemic challenges together enhance the production of HOCl and the fluoroprobe RHQ may be used as a novel diagnostic marker to evaluate the extent of this toxicity.

Symptomatic accidental introduction of disinfectant electrolytic chloroxidizer solution into the peritoneal cavity of CAPD patients. Incidence and long-term effects on ultrafiltration.

In recent years the Y-set with disinfectant [Buoncristiani et al. 1983] has been used in several continuous ambulatory peritoneal dialysis (CAPD) centers. This system has considerably improved the short- and long-term results of CAPD [Maiorca et al. 1983, Scalamogna et al. 1990]. Accidental introduction of disinfectant during the exchange is a risk associated with this system, but at the present time we have little data pertaining to incidence complication and its possible effects on peritoneal function. The aim of the present study was to assess the incidence of acute symptomatic accidental introduction of disinfectant in CAPD patients on the Y system and to establish whether this complication is followed by any long-term changes in peritoneal ultrafiltration.

Severe hypoxaemia due to methaemoglobinaemia and aspiration pneumonia.

The authors report a case of a previously healthy 40-year-old man who was admitted to the emergency department due to severe hypoxaemia after emesis. He vomited after a cup of coffee with the milk at his office. On admission, he showed cyanosis and oxygen saturation measured by pulse oximetry was extremely low (86%) in spite of the administration of 10 litres of oxygen. The authors suspected pneumonia, but oxygen saturation was disproportionately low to pneumonia severity. Oxygen saturation measured by pulse oximetry was significantly different from oxygen saturation calculated from arterial blood gas analysis, suggesting the existence of haemoglobin abnormality. The level of methaemoglobin was 9.3% (reference range, 1-2%). The patient was treated by antibiotics for pneumonia, and his methaemoglobinaemia was spontaneously ameliorated. The authors later found that the patient drank bleach containing hypochlorous acid instead of milk by mistake. To conclude, the patient's hypoxaemia was due to pneumonia and drug-induced acquired methaemoglobinaemia.

Loss of GSH and thiol enzymes in endothelial cells exposed to sublethal concentrations of hypochlorous acid.

We investigated the effect of sublethal concentrations of hypochlorous acid (HOCl) on intracellular thiol groups. Exposure of human umbilical vein endothelial cells to HOCl caused a decrease in cell viability, with concentrations of