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1.
A A Pract ; 14(9): e01287, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32909713

RESUMO

Methemoglobinemia is a rare disorder of the blood in which there is an increase in methemoglobin, which occurs when hemoglobin is present in the oxidized form. Methemoglobin impairs hemoglobin's ability to transport oxygen, produces functional anemia, and leads to tissue hypoxia. We report the successful management of a case of refractory hypoxia due to acutely acquired methemoglobinemia in a patient undergoing treatment for coronavirus disease 2019 (COVID-19) pneumonia. The cause of methemoglobinemia in this patient remains unknown. Hypoxia and methemoglobinemia did not respond to methylene blue and required administration of packed red blood cell transfusions.


Assuntos
Infecções por Coronavirus/complicações , Hipóxia/etiologia , Metemoglobinemia/complicações , Pneumonia Viral/complicações , Insuficiência Respiratória/etiologia , Lesão Renal Aguda/complicações , Lesão Renal Aguda/terapia , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Corynebacterium , Infecções por Corynebacterium/complicações , Infecções por Corynebacterium/terapia , Síndrome da Liberação de Citocina/complicações , Inibidores Enzimáticos/uso terapêutico , Transfusão de Eritrócitos , Hematínicos/uso terapêutico , Humanos , Hidroxocobalamina/uso terapêutico , Hidroxicloroquina/uso terapêutico , Hipóxia/terapia , Masculino , Metemoglobinemia/terapia , Azul de Metileno/uso terapêutico , Pandemias , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/terapia , Pneumonia Viral/tratamento farmacológico , Terapia de Substituição Renal , Insuficiência Respiratória/terapia , Choque Séptico/complicações
3.
Crit Care ; 23(1): 421, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31870461

RESUMO

BACKGROUND: The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored. METHODS: We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models. RESULTS: Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively. CONCLUSION: Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03558646.


Assuntos
Lesão Renal Aguda/prevenção & controle , Hidroxocobalamina/uso terapêutico , Lesão por Inalação de Fumaça/tratamento farmacológico , Lesão Renal Aguda/epidemiologia , Adulto , Feminino , França/epidemiologia , Hematínicos/farmacologia , Hematínicos/uso terapêutico , Humanos , Hidroxocobalamina/farmacologia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fumaça/efeitos adversos , Lesão por Inalação de Fumaça/epidemiologia , Lesão por Inalação de Fumaça/mortalidade
4.
BMC Pregnancy Childbirth ; 19(1): 318, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470807

RESUMO

BACKGROUND: Cobalamin metabolism disorders are rare, inherited diseases which cause megaloblastic anaemia and other clinical manifestations. Early diagnosis of these conditions is essential, in order to allow appropriate treatment as early as possible. CASE PRESENTATION: Here we report the case of a patient who was apparently healthy until the age of 20, when she presented with impaired renal function and normocytic anaemia. At the age of 34, when her first pregnancy resulted in an intrauterine death of a morphologically normal growth-restricted foetus, she was diagnosed with homocystinuria and methylmalonic aciduria due to cyanocobalamin C (cblC) defect, which was confirmed by molecular investigation. Consequently, hydroxocobalamin was administered to correct homocysteine plasma levels. This treatment was efficacious in lowering homocysteine plasma levels and restored anaemia and renal function. During a second pregnancy, the patient was also administered a prophylactic dose of low molecular -weight heparin. The pregnancy concluded with a full-term delivery of a healthy male. CONCLUSIONS: This case emphasises the importance of awareness and appropriate management of rare metabolic diseases during pregnancy. We suggest that women with late-onset cblC defect can have a positive pregnancy outcome if this metabolic disease is treated adequately.


Assuntos
Anticoagulantes/uso terapêutico , Enoxaparina/uso terapêutico , Homocistinúria/tratamento farmacológico , Hidroxocobalamina/uso terapêutico , Leucovorina/uso terapêutico , Complicações na Gravidez/tratamento farmacológico , Deficiência de Vitamina B 12/congênito , Complexo Vitamínico B/uso terapêutico , Aborto Espontâneo , Adulto , Feminino , Retardo do Crescimento Fetal , Homocistinúria/diagnóstico , Humanos , Gravidez , Resultado da Gravidez , Deficiência de Vitamina B 12/diagnóstico , Deficiência de Vitamina B 12/tratamento farmacológico
5.
Mil Med Res ; 6(1): 10, 2019 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-30961671

RESUMO

Inhalation injury is often associated with burns and significantly increases morbidity and mortality. The main toxic components of fire smoke are carbon monoxide, hydrogen cyanide, and irritants. In the case of an incident at a nuclear power plant or recycling facility associated with fire, smoke may also contain radioactive material. Medical treatments may vary in different countries, and in this paper, we discuss the similarities and differences in the treatments between China and Germany. Carbon monoxide poisoning is treated by 100% oxygen administration and, if available, hyperbaric oxygenation in China as well as in Germany. In addition, antidotes binding the cyanide ions and relieving the respiratory chain are important. Methemoglobin-forming agents (e.g., nitrites, dimethylaminophenol) or hydroxocobalamin (Vitamin B12) are options. The metabolic elimination of cyanide may be enhanced by sodium thiosulfate. In China, sodium nitrite with sodium thiosulfate is the most common combination. The use of dimethylaminophenol instead of sodium nitrite is typical for Germany, and hydroxocobalamin is considered the antidote of choice if available in cases of cyanide intoxications by fire smoke inhalation as it does not further reduce oxygen transport capacity. Systematic prophylactic use of corticosteroids to prevent toxic pulmonary edema is not recommended in China or Germany. Stable iodine is indicated in the case of radioiodine exposure and must be administered within several hours to be effective. The decorporation of metal radionuclides is possible with Ca (DTPA) or Prussian blue that should be given as soon as possible. These medications are used in both countries, but it seems that Ca (DTPA) is administered at lower dosages in China. Although the details of the treatment of inhalation injury and radionuclide(s) decorporation may vary, the general therapeutic strategy is very similar in China and Germany.


Assuntos
Exposição por Inalação/efeitos adversos , Exposição à Radiação/efeitos adversos , Lesão por Inalação de Fumaça/tratamento farmacológico , Antídotos/uso terapêutico , Monóxido de Carbono/efeitos adversos , Monóxido de Carbono/metabolismo , Monóxido de Carbono/toxicidade , China , Alemanha , Humanos , Cianeto de Hidrogênio/efeitos adversos , Cianeto de Hidrogênio/metabolismo , Cianeto de Hidrogênio/toxicidade , Hidroxocobalamina/uso terapêutico , Oxigenação Hiperbárica/métodos , Radiografia/métodos , Radioisótopos/efeitos adversos , Radioisótopos/metabolismo , Radioisótopos/toxicidade , Lesão por Inalação de Fumaça/complicações , Lesão por Inalação de Fumaça/metabolismo , Nitrito de Sódio/uso terapêutico , Tiossulfatos/uso terapêutico
6.
Clin Med (Lond) ; 19(2): 129-130, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30872294

RESUMO

An 18-year-old female patient presented to the emergency department with non-specific neurological and gastrointestinal symptoms and was found to be pancytopenic. Her vitamin B12 level was low with a normal mean corpuscular volume and her full blood count 2 months previously had been within normal range. She reported heavy use of nitrous oxide over the previous 2 weeks and other investigations revealed no cause for her pancytopenia. Her pancytopenia resolved with discontinuation of nitrous oxide and vitamin B12 treatment. Heavy use of nitrous oxide should be considered as a cause of pancytopenia.


Assuntos
Óxido Nitroso/efeitos adversos , Pancitopenia/etiologia , Deficiência de Vitamina B 12 , Adolescente , Feminino , Humanos , Hidroxocobalamina/administração & dosagem , Hidroxocobalamina/uso terapêutico , Deficiência de Vitamina B 12/induzido quimicamente , Deficiência de Vitamina B 12/complicações , Deficiência de Vitamina B 12/tratamento farmacológico
9.
Anesth Analg ; 129(1): e1-e4, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-29979199

RESUMO

Hydroxocobalamin (vitamin B12a) is an emerging treatment for vasoplegic syndrome (VS) associated with cardiopulmonary bypass (CPB). Given its cost and scarcity, an institutional guideline for its use as a rescue treatment in cases of suspected VS was developed. Hemodynamic variables and vasopressor requirements were reviewed for a series of 24 post-CPB patients who received B12a. Favorable changes in hemodynamic parameters and vasopressor requirements were seen after B12a administration although guideline criteria for VS were inconsistently met. These findings support the continued study of B12a in patients with CPB-associated VS.


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Hemodinâmica/efeitos dos fármacos , Hidroxocobalamina/uso terapêutico , Hipotensão/tratamento farmacológico , Vasoconstritores/uso terapêutico , Vasoplegia/tratamento farmacológico , Complexo Vitamínico B/uso terapêutico , Idoso , Feminino , Humanos , Hidroxocobalamina/efeitos adversos , Hipotensão/diagnóstico , Hipotensão/epidemiologia , Hipotensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Vasoconstritores/efeitos adversos , Vasoplegia/diagnóstico , Vasoplegia/etiologia , Vasoplegia/fisiopatologia , Complexo Vitamínico B/efeitos adversos
10.
Eur J Nutr ; 58(1): 261-270, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29209773

RESUMO

PURPOSE: We compare the effect of 8-week oral supplementation with cyano-B12 (currently used in vitamin pills) and hydroxo-B12 (predominant form in the diet) in a population with nutritional vitamin B12 deficiency. METHODS: Fifty-one healthy Indian adults with baseline serum cobalamin < 200 pmol/L were supplied for 8 weeks with daily oral supplements of 3-µg cyano-B12 (n = 15), 3-µg hydroxo-B12 (n = 16), or a placebo (n = 20). Blood at baseline, and each following week, was examined for total cobalamin, holotranscobalamin, methylmalonic acid, and homocysteine. RESULTS: The study groups did not differ at baseline and were characterized by [median (range)] serum cobalamin [128 (68-191) pmol/L], holotranscobalamin [16 (6-41) pmol/L], methylmalonic acid [0.8 (0.3-1.7) µmol/L], homocysteine [17.9 (8.5-100.9) µmol/L], and a combined indicator of B12 status 4cB12 of - 1.65 (- 0.64 to - 4.07). The group supplemented with cyano-B12 showed a higher increase in total serum cobalamin than the group treated with hydroxo-B12, while other biomarkers changed comparably in the two groups. After 8 weeks of treatment, the biomarker values of the supplemented groups (pooled) differed significantly from the placebo group. Yet, the vitamin B12 status was still poor [cobalamin: 168 (87-302) pmol/L; holotranscobalamin: 19 (8-45) pmol/L; methylmalonic acid: 0.7 (0.2-1.7) µmol/L; homocysteine: 17.2 (2.6-96.8) µmol/L; 4cB12 = - 1.34 (- 0.33 to - 3.3)]. CONCLUSION: 8-week supplementation with 3-µg cyano-B12 elevated serum cobalamin more than 3 µg hydroxo-B12, but all other biomarkers changed similarly in both groups. Supplementation with 3 µg vitamin B12 did not reverse the low status in individuals with nutritional vitamin B12 deficiency. CLINICAL TRIAL REGISTRY OF INDIA: REF/2017/02/013343.


Assuntos
Suplementos Nutricionais , Hidroxocobalamina/uso terapêutico , Deficiência de Vitamina B 12/tratamento farmacológico , Vitamina B 12/uso terapêutico , Complexo Vitamínico B/uso terapêutico , Administração Oral , Adulto , Biomarcadores/sangue , Estudos de Coortes , Feminino , Humanos , Hidroxocobalamina/administração & dosagem , Hidroxocobalamina/sangue , Índia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Vitamina B 12/administração & dosagem , Vitamina B 12/sangue , Complexo Vitamínico B/administração & dosagem , Complexo Vitamínico B/sangue , Adulto Jovem
11.
Clin Exp Pharmacol Physiol ; 46(3): 216-225, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30575111

RESUMO

Early, non-clinical studies support the use of hydroxocobalamin to treat sepsis-induced hypotension, but there is no translational, large animal model. The objective of this study was to compare survival in a sepsis model where large swine had endotoxaemia induced with lipopolysaccharide (LPS) and were treated with intravenous hydroxocobalamin (HOC), noradrenaline (NA), or saline. Thirty swine (45-55 kg) were anaesthetized, intubated, and instrumented with continuous femoral and pulmonary artery pressure monitoring. Hypotension, predefined as 50% of baseline, was induced with LPS. Animals then received HOC, NA, or saline and monitored for 3 hours. The main outcome was survival to the conclusion of the study. Using a power of 80% and an alpha of 0.05, 10 animals were used per group. Secondary outcomes included: mean arterial pressure (MAP), systemic vascular resistance (SVR) and cardiac output (CO) along with several markers of sepsis. No differences were detected between groups at baseline or after hypotension. The survival distributions of the three groups were significantly different with more HOC animals surviving (10/10) compared with NA (8/10) or Saline (5/10) (log-rank P < 0.03). MAP was found to be higher in both the HOC and NA groups and HOC achieved the highest SVR. In this large animal, translational study of an endotoxaemic model of sepsis, hydroxocobalamin improved survival when compared with saline.


Assuntos
Hidroxocobalamina/farmacologia , Hipotensão/tratamento farmacológico , Lipopolissacarídeos/efeitos adversos , Norepinefrina/farmacologia , Solução Salina/farmacologia , Administração Intravenosa , Animais , Biomarcadores/sangue , Modelos Animais de Doenças , Feminino , Gases/sangue , Hemodinâmica/efeitos dos fármacos , Hidroxocobalamina/administração & dosagem , Hidroxocobalamina/uso terapêutico , Hipotensão/complicações , Hipotensão/metabolismo , Hipotensão/fisiopatologia , Norepinefrina/administração & dosagem , Norepinefrina/uso terapêutico , Solução Salina/administração & dosagem , Solução Salina/uso terapêutico , Choque Séptico/complicações , Suínos
12.
BMJ Case Rep ; 11(1)2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30567139

RESUMO

A 34-year-old previously well woman presented with a 4-week history of diffuse erythema and crusting of skin affecting all four limbs. Examination revealed erythematous skin plaques associated with ulceration and fissuring affecting sun-exposed areas of all four limbs primarily on the dorsal surfaces, and a body mass index of 17 kg/m2 She was admitted under the infectious diseases unit, and an autoimmune and infective screen was performed which returned unremarkable. Dietetic consultation led to the diagnosis of severe protein-energy malnutrition, consequent to a severely restricted, primarily vegan, diet. Analysis of the patient's reported diet with nutritional software revealed grossly suboptimal caloric intake with risk of inadequacy for most micronutrients, vitamins and minerals, including niacin. Oral thiamine, multivitamin, iron supplementation and vitamin B complex were started, and a single intramuscular vitamin B12 dose was administered. Marked improvement was seen after 6 weeks, with near-complete resolution of skin changes. These findings supported a diagnosis of pellagra.


Assuntos
Micronutrientes/deficiência , Niacina/deficiência , Pelagra/diagnóstico , Pele/patologia , Dieta Vegana/efeitos adversos , Eritema/etiologia , Eritema/patologia , Feminino , Compostos Ferrosos/administração & dosagem , Compostos Ferrosos/uso terapêutico , Humanos , Hidroxocobalamina/administração & dosagem , Hidroxocobalamina/uso terapêutico , Pelagra/tratamento farmacológico , Pelagra/patologia , Tiamina/administração & dosagem , Tiamina/uso terapêutico , Resultado do Tratamento , Complexo Vitamínico B/administração & dosagem , Complexo Vitamínico B/uso terapêutico
13.
Mil Med ; 183(11-12): e721-e729, 2018 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-30500921

RESUMO

Background: Hydroxyethyl starch (Hextend) has been used for hemorrhagic shock resuscitation, however, hydroxyethyl starch may be associated with adverse outcomes. Objective: To compare systolic blood pressure (sBP) in animals that had 30% of their blood volume removed and treated with intravenous hydroxocobalamin, hydroxyethyl starch, or no fluid. Methods: Twenty-eight swine (45-55 kg) were anesthetized and instrumented with continuous femoral and pulmonary artery pressure monitoring. Animals were hemorrhaged 20 mL/kg over 20 minutes and then administered 150 mg/kg IV hydroxocobalamin in 180 mL saline, 500 mL hydroxyethyl starch, or no fluid and monitored for 60 minutes. Data were modeled using repeated measures multivariate analysis of variance. Results: There were no significant differences before treatment. At 20 minutes after hemorrhage, there was no significant difference in mean sBP between treated groups, however, control animals displayed significantly lower mean sBP (p < 0.001). Mean arterial pressure and heart rate improved in the treated groups but not in the control group (p < 0.02). Prothrombin time was longer and platelet counts were lower in the Hextend group (p < 0.05). Moreover, thromboelastography analysis showed longer clotting (K) times (p < 0.05) for the hydroxyethyl starch-treated group. Conclusion: Hydroxocobalamin restored blood pressure more effectively than no treatment and as effectively as hydroxyethyl starch but did not adversely affect coagulation.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Hemorragia/tratamento farmacológico , Hidroxocobalamina/farmacologia , Derivados de Hidroxietil Amido/farmacologia , Ressuscitação/métodos , Administração Intravenosa , Animais , Coagulação Sanguínea/efeitos dos fármacos , Modelos Animais de Doenças , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/estatística & dados numéricos , Hidroxocobalamina/normas , Hidroxocobalamina/uso terapêutico , Derivados de Hidroxietil Amido/normas , Derivados de Hidroxietil Amido/uso terapêutico , Ressuscitação/normas , Suínos
14.
J Pediatr ; 202: 315-319.e2, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30057141

RESUMO

We describe 2 children with cobalamin G disease, a disorder of vitamin B12 metabolism with normal serum B12 levels. They presented with megaloblastic anemia progressing rapidly to severe thrombotic microangiopathy. In infants presenting with acute thrombotic microangiopathy, cobalamin disorders should be considered early as diagnosis and targeted treatment can be lifesaving.


Assuntos
Anemia Megaloblástica/diagnóstico , Anemia Megaloblástica/tratamento farmacológico , Progressão da Doença , Hidroxocobalamina/uso terapêutico , Microangiopatias Trombóticas/tratamento farmacológico , Microangiopatias Trombóticas/etiologia , Anemia Megaloblástica/sangue , Anemia Megaloblástica/complicações , Análise Química do Sangue , Transfusão de Sangue/métodos , Pré-Escolar , Diagnóstico Precoce , Insuficiência de Crescimento , Testes Hematológicos , Humanos , Lactente , Injeções Intramusculares , Masculino , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Deficiência de Vitamina B 12/sangue , Deficiência de Vitamina B 12/diagnóstico
15.
Am J Transplant ; 18(6): 1552-1555, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29573551

RESUMO

A 66-year-old man with cryptogenic cirrhosis secondary to nonalcoholic steatohepatitis presented for orthotopic liver transplantation. Following organ reperfusion, the patient developed vasoplegic syndrome, with arterial blood pressures of approximately 60-70/30-40 mm Hg (mean arterial pressure [MAP] <45 mm Hg) for >90 minutes. He required high-dose norepinephrine and vasopressin infusions, as well as i.v. bolus doses of norepinephrine and vasopressin to reach a goal MAP> 60 mm Hg. There was minimal response to a 2 mg/kg i.v. bolus of methylene blue. Following the administration of 5 g of i.v.hydroxocobalamin, the patient had a profound improvement in arterial blood pressure, with subsequent discontinuation of the vasopressin infusion and rapid reduction of norepinephrine infusion from 20 to 2 µg/min. While there have been several reports of the efficacy of hydroxocobalamin for vasoplegia after cardiopulmonary bypass, there have been only limited cases of hydroxocobalamin used in liver transplantation, and none with high-dose administration. We present a case of vasoplegic syndrome during liver transplantation that was refractory to high-dose vasopressors and methylene blue but responsive to high-dose i.v. hydroxocobalamin.


Assuntos
Hidroxocobalamina/administração & dosagem , Hidroxocobalamina/uso terapêutico , Transplante de Fígado , Vasoplegia/tratamento farmacológico , Idoso , Humanos , Masculino
16.
J Vet Intern Med ; 32(3): 1033-1040, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29572946

RESUMO

BACKGROUND: Prospective studies on maintenance treatment for Beagles with hereditary selective cobalamin (Cbl) malabsorption (Imerslund-Gräsbeck syndrome, IGS) are lacking. In our experience, measurement of methylmalonic acid (MMA), a Cbl-dependent metabolite, seems more helpful to monitor Cbl status as compared with serum Cbl concentrations. OBJECTIVES: To evaluate a standardized Cbl supplementation scheme in Beagles with IGS. We hypothesized that a single parenteral dose of 1 mg hydroxocobalamin (OH-Cbl) would maintain clinical and metabolic remission for up to 2 months. ANIMALS: Six client-owned juvenile Beagles with genetically confirmed IGS and 28 healthy control dogs. METHODS: Prospective study. Monthly IM OH-Cbl (1 mg) supplementation was done over a median of 9 months (range, 6-13) in 6 dogs, followed by bimonthly (every 2 months) injections in 5 dogs over a median of 6 months (range, 3-10). Health status was assessed by routine clinical examinations at injection time points and owner observations. Voided urine samples were collected immediately before OH-Cbl injections for measurement of MMA-to-creatinine concentrations using a gas-liquid chromatography-tandem mass spectrometry (GC-MS) method. RESULTS: All dogs were clinically healthy while receiving monthly and bimonthly OH-Cbl supplementation. Urinary MMA results in healthy dogs ranged from 1.3 to 76.5 mmol/mol creatinine (median, 2.9). Median urinary MMA concentrations did not differ between dogs with IGS receiving monthly (n = 49; 5.3 mmol/mol creatinine; range, 2.3-50.4) and bimonthly (n = 31; 5.3 mmol/mol creatinine; range, 1.6-50) injections. CONCLUSIONS AND CLINICAL IMPORTANCE: A maintenance parenteral dose of 1 mg OH-Cbl monthly or bimonthly appears adequate in Beagles with IGS monitored by metabolic testing.


Assuntos
Anemia Megaloblástica/veterinária , Doenças do Cão/tratamento farmacológico , Hidroxocobalamina/uso terapêutico , Síndromes de Malabsorção/veterinária , Proteinúria/veterinária , Deficiência de Vitamina B 12/veterinária , Anemia Megaloblástica/tratamento farmacológico , Animais , Creatinina/urina , Cães , Esquema de Medicação/veterinária , Feminino , Hidroxocobalamina/administração & dosagem , Injeções Intramusculares/veterinária , Síndromes de Malabsorção/tratamento farmacológico , Masculino , Ácido Metilmalônico/urina , Estudos Prospectivos , Proteinúria/tratamento farmacológico , Vitamina B 12/sangue , Vitamina B 12/urina , Deficiência de Vitamina B 12/tratamento farmacológico
17.
Burns ; 44(5): 1040-1051, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29398078

RESUMO

INTRODUCTION: Smoke inhalation injury (II) is an independent risk factor for mortality in burns and its management is inherently complex. We aim to make recommendations for best practice in managing II and its sequelae by reviewing all available current evidence in order to provide an evidence-based approach. METHODS: We conducted a systematic search of the Cochrane database and Embase using PRISMA guidelines with no patient population exclusion criteria. Published work was reviewed and evidence levels graded. RESULTS: We identified 521 abstracts for inclusion. Of the 84 articles identified for secondary review, 28 papers were excluded leaving 56 papers suitable for final inclusion. CONCLUSIONS: We are able to identify a number of strategies in both diagnosis and treatment of II that have support in the published literature, including the role of bronchoscopy, permissive hypercapnia, nebulized heparin and hydroxycobalamin. Other strategies have not been shown to be harmful, but their efficacy is also not firmly established, such as high frequency oscillatory ventilation and exogenous surfactant. Prophylactic antibiotics and corticosteroids are not recommended. In general, published evidence for II is mostly Level 3 or below, due to a noticeable lack of large-scale human studies. This represents a challenge for evidence-based burns practice as a whole.


Assuntos
Anti-Infecciosos/uso terapêutico , Anticoagulantes/uso terapêutico , Heparina/uso terapêutico , Ventilação de Alta Frequência/métodos , Surfactantes Pulmonares/uso terapêutico , Lesão por Inalação de Fumaça/terapia , Complexo Vitamínico B/uso terapêutico , Administração por Inalação , Broncoscopia , Medicina Baseada em Evidências , Humanos , Hidroxocobalamina/uso terapêutico , Hipercapnia , Lesão por Inalação de Fumaça/diagnóstico
18.
Am J Emerg Med ; 36(5): 851-853, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29395761

RESUMO

BACKGROUND: Carbon monoxide and cyanide poisoning are important causes of death due to fire. Carbon monoxide is more regularly assessed than cyanide at the site of burn or smoke inhalation treatment due to its ease in assessment and simplicity to treat. Although several forensic studies have demonstrated the significance of cyanide poisoning in fire victims using blood cyanide levels, the association between the cause of cardiac arrest and the concentration of cyanide among fire victims has not been sufficiently investigated. This study aimed to investigate the frequency of cyanide-induced cardiac arrest in fire victims and to assess the necessity of early empiric treatment for cyanide poisoning. METHODS: This study was a retrospective analysis of fire victims with cardiac arrest at the scene who were transported to a trauma and critical care center, Kyorin University Hospital, from January 2014 to June 2017. Patients whose concentration of cyanide was measured were included. RESULTS: Five patients were included in the study; all died despite cardiopulmonary resuscitation. Three of these victims were later found to have lethal cyanide levels (>3 µg/ml). Two of the patients had non-lethal carboxyhemoglobin levels under 50% and might have been saved if hydroxocobalamin had been administered during resuscitation. CONCLUSION: According to our results, cyanide-induced cardiac arrest may be more frequently present among fire victims than previously believed, and early empiric treatment with hydroxocobalamin may improve outcomes for these victims in cases where cardiac arrest is of short duration.


Assuntos
Intoxicação por Monóxido de Carbono/mortalidade , Cianetos/envenenamento , Fogo , Parada Cardíaca Extra-Hospitalar/etiologia , Lesão por Inalação de Fumaça/mortalidade , Idoso , Carboxihemoglobina/metabolismo , Cianetos/sangue , Feminino , Humanos , Hidroxocobalamina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Lesão por Inalação de Fumaça/tratamento farmacológico
20.
Clin Toxicol (Phila) ; 56(5): 370-372, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28969436

RESUMO

CONTEXT: Hydroxocobalamin is an effective cyanide antidote. While erythema, hypertension, and chromaturia are recognized side effects, methemoglobinemia has not been reported. Methemoglobin levels are most accurately measured by co-oximetry. We describe an extensively burned patient who developed methemoglobinemia within an hour of hydroxocobalamin administration. CASE DETAILS: A 47-year old man without genetic deficiencies or abnormal hemoglobin variants presented with 61% body surface area thermal burns and grade 1 inhalation injury sustained during a tugboat engine explosion. On admission, lactate was 9.24 mmol/L, methemoglobin 1%, and carboxyhemoglobin 0.2% by blood gas analysis with co-oximetry. Despite large-volume resuscitation, lactate remained elevated (7-8 mmol/L). Intravenous hydroxocobalamin (5 g) was administered at postburn hour 19 for possible cyanide toxicity. Immediately thereafter, he became hypertensive with reflex bradycardia. Lactate decreased to 5.51 mmol/L, methemoglobin rose to 4.10%, and oxygen saturation by pulse oximetry decreased to 74-80% (despite arterial oxygen saturation of 95% by cooximetry). Methemoglobin concentration peaked at 13.40% at postburn hour 33. Methylene blue was not administered. CONCLUSIONS: Methemoglobinemia in our patient was temporally associated with hydroxocobalamin administration.


Assuntos
Antídotos/efeitos adversos , Queimaduras por Inalação/complicações , Queimaduras/complicações , Cianetos/envenenamento , Hidroxocobalamina/efeitos adversos , Metemoglobinemia/induzido quimicamente , Antídotos/uso terapêutico , Humanos , Hidroxocobalamina/uso terapêutico , Masculino , Pessoa de Meia-Idade
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