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1.
Orv Hetil ; 162(8): 306-313, 2021 02 21.
Artigo em Húngaro | MEDLINE | ID: mdl-33611266

RESUMO

Összefoglaló. A methaemoglobinaemia az oxigén szállítására képtelen methemoglobin szintjének kóros emelkedését jelenti a vérben, ami jelentos szöveti oxigénhiányt okozhat, súlyos, akár életveszélyes tünetekhez vezethet. Methaemoglobinaemiát számos, oxidáló hatású exogén anyag idézhet elo, ezek közé tartoznak a partidrogként használt alkil-nitritek, az ún. "popperek" is. A "poppereket" korábban "alacsony rizikójú" drogként tartották számon, azonban számos esetet közöltek, amikor súlyos, idonként fatális kimenetelu methaemoglobinaemiát okoztak. A folyadékok gozének belélegzése euforizáló, szexuálisvágy-fokozó és simaizom-lazító hatású, ezért a "popperek" igen népszeruek a homo- és biszexuális férfiak körében, de fiatal felnottek és tinédzserek is használják. A folyadékok szájon át való fogyasztása különösen veszélyes. A szerzok két esetet ismertetnek, amelyekben a "popperek" használatát követoen methaemoglobinaemia alakult ki. Mindkét betegnél, a jó általános állapot mellett, centrális és perifériás cyanosis tüneteit észlelték. Az alkalmazás módja (inhaláció/lenyelés), a methaemoglobinaemia súlyossága (16,4% és 57%) és a terápia eltéro volt a két betegnél. Az elso beteg oxigén adása és tüneti kezelés mellett gyógyult, a másodiknál antidotum (metilénkék) adására is szükség volt. Mindketten panaszmentesen távoztak a kórházból. A szerzok célja az volt, hogy felhívják a figyelmet az illékony alkil-nitrit-származékok által okozott methaemoglobinaemiára, annak felismerésére, kezelésére, és bemutassák azok kevésbé ismert szövodményeit is. Orv Hetil. 2021; 162(8): 306-313. Summary. Methemoglobinemia means the abnormally elevated level of methemoglobin in the blood, which is incapable of oxygen transport, accordingly it can cause significant tissue hypoxia, leading to severe or even life-threatening clinical symptoms. Several exogen oxidative agents can induce methemoglobinemia, including alkyl-nitrites which are also used as party drugs, the so-called 'poppers'. The 'poppers' were previously considered 'low-risk' drugs, however, several cases have been published when they caused severe, sometimes fatal methemoglobinemia. Inhaling vapours from liquids has euphoric, smooth-muscle relaxing and aphrodisiac effects, therefore 'poppers' are extremely popular among gay and bisexual men but also used by young adults and teenagers. Oral consumption of the fluids is particularly dangerous. The authors present two cases when methemoglobinemia developed after 'poppers' usage. Both patients were in good general condition and symptoms of central and peripheral cyanosis were detected. The method of application (inhalation/ ingestion), the severity of methemoglobinemia (16,4% and 57%) and the treatment were different in the two patients. The first patient recovered with inhalation of oxygen and symptomatic treatment; the second patient required administration of antidote (methylene blue). Both patients left the hospital without complaints. The authors' aim was to attract attention to methemoglobinemia caused by volatile alkyl-nitrites, its recognition, treatment and to present their lesser-known complications. Orv Hetil. 2021; 12(8): 306-313.


Assuntos
Drogas Ilícitas/efeitos adversos , Metemoglobinemia , Nitritos/efeitos adversos , Adolescente , Antídotos , Humanos , Masculino , Metemoglobinemia/induzido quimicamente , Adulto Jovem
2.
Vnitr Lek ; 66(6): 46-52, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33380153

RESUMO

Methemoglobinemia is rare condition of hem iron. Ferrous form iron (Fe2+) is oxidised to Ferric form (Fe3+). 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.


Assuntos
Metemoglobinemia , Hospitais , Humanos , Metemoglobinemia/induzido quimicamente , Metemoglobinemia/diagnóstico , Azul de Metileno
6.
Artigo em Inglês | MEDLINE | ID: mdl-32178428

RESUMO

Background: Methemoglobinemia (MET) should be suspected in cases where cyanosis is not associated with signs and symptoms of lung and/or heart disease, or in a cyanotic child exhibiting discrepancies in the partial pressure of oxygen in the arterial blood, the blood oxygen saturation, and the clinical assessment. Case presentation: A 10-month-old girl was taken to the Pediatric Emergency Department for the acute, sudden development of significant peroral cyanosis associated with gray pigmentation of the skin. The problem was evidenced approximately one hour after she ingested a homemade puree of mixed vegetables, mainly composed of potatoes and chards that had been prepared three days before and had been kept in the refrigerator since then. Physical examination revealed that the child was very pale, conscious, and without respiratory distress. Oxygen saturation of hemoglobin in the arterial blood (SpO2) was 94%. Respiratory, cardiovascular, and abdominal evaluations did not reveal any signs of disease. A venous blood sample showed chocolate-colored blood with a pH of 7.404, a partial pressure of CO2 (pCO2) of 40.6 mmHg, a partial pressure of oxygen (pO2) of 21.3 mmHg, a bicarbonate level of 24 mmol/L, and an oxygen saturation (SO2%) of 47.7%. CO-oximetry carried out simultaneously identified a methemoglobin level of 22%. MET was suspected, and oxygen via nasal cannula at a rate of 4 L/min was given with only a slight increase in oxygen saturation (96%). Slow intravenous injection of methylene blue 1 mg/kg over a period of 5 min was initiated. The peripheral oxygen saturation (SpO2) gradually improved to 100% over the next 20 min. Forty minutes later, venous blood gas analysis showed a methemoglobin level of 0.9% with a complete resolution of cyanosis; supplemental oxygen via nasal cannula was therefore discontinued. During the next 36 h, the patient remained hemodynamically stable with good oxygenation on room air. Conclusions: This case report shows that recognition of acquired MET in a child with sudden cyanosis onset requires a high index of suspicion. In daily activities, there is a need to pay particular attention when homemade vegetable soups for child alimentation are prepared. The consumption of vegetable soups must occur immediately after preparation. Storage in a refrigerator must last no more than 24 h and if longer storage is needed, vegetable soups should be frozen.


Assuntos
Contaminação de Alimentos , Metemoglobinemia , Venenos , Gasometria , Cianose , Feminino , Contaminação de Alimentos/análise , Humanos , Lactente , Metemoglobinemia/induzido quimicamente , Metemoglobinemia/etiologia , Oximetria , Venenos/toxicidade
7.
Biochemistry ; 59(8): 911-920, 2020 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-32073254

RESUMO

There is a pressing need for compounds with broad-spectrum activity against malaria parasites at various life cycle stages to achieve malaria elimination. However, this goal cannot be accomplished without targeting the tenacious dormant liver-stage hypnozoite that causes multiple relapses after the first episode of illness. In the search for the magic bullet to radically cure Plasmodium vivax malaria, tafenoquine outperformed other candidate drugs and was approved by the U.S. Food and Drug Administration in 2018. Tafenoquine is an 8-aminoquinoline that inhibits multiple life stages of various Plasmodium species. Additionally, its much longer half-life allows for single-dose treatment, which will improve the compliance rate. Despite its approval and the long-time use of other 8-aminoquinolines, the mechanisms behind tafenoquine's activity and adverse effects are still largely unknown. In this Perspective, we discuss the plausible underlying mechanisms of tafenoquine's antiparasitic activity and highlight its role as a cellular stressor. We also discuss potential drug combinations and the development of next-generation 8-aminoquinolines to further improve the therapeutic index of tafenoquine for malaria treatment and prevention.


Assuntos
Aminoquinolinas/uso terapêutico , Antimaláricos/uso terapêutico , Malária Vivax/tratamento farmacológico , Aminoquinolinas/efeitos adversos , Anemia Hemolítica/induzido quimicamente , Animais , Antimaláricos/efeitos adversos , Citocromo P-450 CYP2D6/genética , Citocromo P-450 CYP2D6/metabolismo , Técnicas de Silenciamento de Genes , Deficiência de Glucosefosfato Desidrogenase/metabolismo , Haplorrinos , Humanos , Metemoglobinemia/induzido quimicamente , Camundongos , Plasmodium cynomolgi/efeitos dos fármacos , Plasmodium vivax/efeitos dos fármacos , Peixe-Zebra
8.
BMJ Case Rep ; 13(1)2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31969408

RESUMO

Methaemoglobinaemia is an extremely rare condition with multiple causes, both genetic and acquired. We present a severe case of methaemoglobinaemia occurring in a Brazilian hairdresser working in the UK. She presented after several days of preparing popular 'Brazilian blowdry' treatments for customers at a hair salon. She had been exposed to multiple volatile chemicals, including formaldehyde, without any respiratory protection, and we postulate that this may have caused her illness. If so, this would be the first published case of methaemoglobinaemia caused by exposure to the volatile components of beauty products.


Assuntos
Poluentes Ocupacionais do Ar/efeitos adversos , Preparações para Cabelo/efeitos adversos , Metemoglobinemia/induzido quimicamente , Metemoglobinemia/tratamento farmacológico , Azul de Metileno/uso terapêutico , Exposição Ocupacional/efeitos adversos , Inibidores Enzimáticos/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade
9.
N Z Med J ; 133(1508): 123-126, 2020 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945049

RESUMO

Methotrexate monotherapy is a common management strategy in rheumatoid arthritis (RA). Treatment with immunosuppression can lead to opportunistic infections such as Pneumocystis jirovecii pneumonia (PJP). The treatment options for PJP include cotrimoxazole, clindamycin-primaquine and dapsone. Though these drugs are generally well tolerated, they can result in potentially severe adverse effects. Sometimes several undesired events may occur in a single patient, reminding us of Murphy's law. Herein, we report a case which exemplifies this adage. A 50-year-old female developed PJP, while on methotrexate therapy for RA and was treated with cotrimoxazole. The latter resulted in painful peripheral neuropathy, which improved after cotrimoxazole was stopped. Salvage therapy for PJP with primaquine-clindamycin, lead to another serious adverse event, methemoglobinemia. Withdrawing the offending drug resulted in dramatic improvement.


Assuntos
Aplicação da Lei/métodos , Metemoglobinemia/induzido quimicamente , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Pneumonia por Pneumocystis/tratamento farmacológico , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Antimaláricos/efeitos adversos , Antimaláricos/uso terapêutico , Clindamicina/efeitos adversos , Clindamicina/uso terapêutico , Dapsona/efeitos adversos , Dapsona/uso terapêutico , Quimioterapia Combinada/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Pneumonia por Pneumocystis/complicações , Primaquina/efeitos adversos , Primaquina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Suspensão de Tratamento
12.
Clin Toxicol (Phila) ; 58(6): 495-497, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31446806

RESUMO

Background: Acetaminophen is a common pharmaceutical ingestion reported to US poison centers. In overdose, toxic metabolites are known to cause hepato- and nephrotoxicity. While G6PD deficiency may be a risk factor for methemoglobin production in the setting of acetaminophen overdose, it is rarely reported in patients who do not have this condition.Methods: We present two cases of methemoglobinemia following massive acetaminophen ingestion with no known history of G6PD deficiency or other substances known to induce methemoglobinemia. The two cases had peak methemoglobin measurements of 32% and 12% respectively, and both were treated with methylene blue.Discussion: A number of mechanisms may be involved in production of methemoglobin in the setting of massive acetaminophen ingestion including NAPQI-induced oxidation, depletion of glutathione stores, and production of oxidant-metabolites including paraaminophenol. While it is unlikely that the majority of acetaminophen overdoses result in any clinically significant methemoglobinemia, massive acetaminophen overdose may be complicated by development of methemoglobinemia.Conclusion: Physicians should be aware of the possibility that massive acetaminophen ingestion may be complicated by methemoglobinemia in rare instances. Further studies should aim to characterize the metabolic pathways leading to possible methemoglobinemia in humans after large acetaminophen ingestions.


Assuntos
Acetaminofen/envenenamento , Overdose de Drogas/etiologia , Metemoglobinemia/induzido quimicamente , Acetaminofen/sangue , Acetaminofen/urina , Overdose de Drogas/sangue , Overdose de Drogas/terapia , Overdose de Drogas/urina , Evolução Fatal , Feminino , Humanos , Masculino , Metemoglobina/análise , Metemoglobinemia/sangue , Metemoglobinemia/terapia , Metemoglobinemia/urina , Azul de Metileno/uso terapêutico , Pessoa de Meia-Idade , Resultado do Tratamento
13.
Rev Med Chil ; 148(12): 1838-1843, 2020 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-33844752

RESUMO

Methemoglobinemia is a rare condition with serious consequences if not diagnosed. We report the case of a 64-year-old woman with a history of allergy to sulfa drugs and a recent diagnosis of a small vessel vasculitis (ANCA-p) who started induction therapy with corticosteroids and rituximab. Due to the need for infectious prophylaxis, and considering her history, dapsone was administered instead of cotrimoxazole after ruling out glucose-6-phosphate dehydrogenase deficiency. During the admission to the hospital for her second dose of rituximab, and while being asymptomatic, she persistently presented a pulse oximetry ≪ 90% despite the administration of O2. Therefore, the infusion was postponed to study the patient. The arterial gasometric study by direct potentiometry revealed an O2 saturation of 98%, with a saturation gap > 5%. Considering the use of dapsone, a methemoglobinemia was suspected and confirmed by co-oximetry (methemoglobinemia 9%). Dapsone was suspended and one week later, her methemoglobinemia was absent.


Assuntos
Dapsona , Metemoglobinemia , Dapsona/efeitos adversos , Feminino , Humanos , Metemoglobinemia/induzido quimicamente , Metemoglobinemia/diagnóstico , Metemoglobinemia/tratamento farmacológico , Pessoa de Meia-Idade , Rituximab , Combinação Trimetoprima e Sulfametoxazol
14.
Lakartidningen ; 1162019 Oct 01.
Artigo em Sueco | MEDLINE | ID: mdl-31573668

RESUMO

Prilocaine/lidocaine is widely used as local anesthetic in children for cannulation and minor surgical procedures. Usually it is unproblematic but it is important to adhere to recommended dose to avoid serious complications. Excessive amount of prilocaine/lidocaine, large application area, prolonged application time or repeated application can, especially in infants, cause methemoglobinemia with clinical symptoms. In severe cases intensive care and antidote treatment with Methylene blue may be required. We report three infants who were overdosed with prilocaine/lidocaine, two of them due to incorrect use after circumcision and one premature baby where prilocaine/lidocaine was not removed in time. Two of the babies had MetHb levels > 33% and were seriously affected with hypoxia, tachycardia and fatigue. After Methylene blue was given the infants recovered within 15 minutes and MetHb levels returned to normal.


Assuntos
Anestésicos Combinados/efeitos adversos , Anestésicos Locais/efeitos adversos , Combinação Lidocaína e Prilocaína/efeitos adversos , Metemoglobinemia/induzido quimicamente , Gasometria , Overdose de Drogas/complicações , Overdose de Drogas/tratamento farmacológico , Inibidores Enzimáticos/administração & dosagem , Inibidores Enzimáticos/uso terapêutico , Humanos , Recém-Nascido , Masculino , Metemoglobinemia/sangue , Metemoglobinemia/tratamento farmacológico , Azul de Metileno/administração & dosagem , Azul de Metileno/uso terapêutico
15.
Am J Emerg Med ; 37(11): 2119.e1-2119.e2, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31477356

RESUMO

This is the case of a 23-year-old female with a past medical history of ADHD and Depression who was evaluated in the emergency department for perioral cyanosis and hypoxia after application of the eutectic mixture of lidocaine and prilocaine (EMLA) local anesthetic prior to a laser-assisted hair removal procedure. This report illustrates a case of methemoglobinemia which is a rare but significant complication of topical anesthetic use.


Assuntos
Anestésicos Locais/efeitos adversos , Remoção de Cabelo , Combinação Lidocaína e Prilocaína/efeitos adversos , Metemoglobinemia/induzido quimicamente , Feminino , Remoção de Cabelo/métodos , Humanos , Metemoglobinemia/diagnóstico , Adulto Jovem
17.
J Spec Oper Med ; 19(3): 14-16, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539427

RESUMO

Presumptive antirelapse therapy (PART) with primaquine for Plasmodium vivax malaria postdeployment is an important component of the US military Force Health Protection plan. While primaquine is well tolerated in the majority of cases, we present a unique case of an active duty Army Ranger without glucose-6-phosphatase dehydrogenase or cytochrome b5 reductase (b5R) deficiencies who developed symptomatic methemoglobinemia while taking PART following a deployment to Afghanistan.


Assuntos
Metemoglobinemia/induzido quimicamente , Metemoglobinemia/diagnóstico , Militares , Primaquina/toxicidade , Campanha Afegã de 2001- , Diagnóstico Tardio , Humanos
18.
Neonatology ; 116(3): 295-298, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31454813

RESUMO

We report the first case of life-threatening extreme neonatal-acquired methemoglobinemia that occurred during inhaled nitric oxide (iNO) at the standard 20 ppm dose in a neonate with early onset sepsis and suprasystemic pulmonary hypertension. Life-threatening methemoglobinemia has been efficaciously treated with methylene blue and ascorbic acid, while stopping iNO and starting iloprost and sildenafil. The patient was subjected to various tests (including gene sequencing and hemoglobin electrophoresis) and did not have any known genetic cause or predisposition for methemoglobinemia. Neuroimaging and the 2-year clinical follow-up were completely normal.


Assuntos
Metemoglobinemia/induzido quimicamente , Óxido Nítrico/efeitos adversos , Síndrome da Persistência do Padrão de Circulação Fetal/tratamento farmacológico , Vasodilatadores/efeitos adversos , Antídotos/uso terapêutico , Substituição de Medicamentos , Humanos , Recém-Nascido , Masculino , Metemoglobinemia/sangue , Metemoglobinemia/diagnóstico , Metemoglobinemia/tratamento farmacológico , Óxido Nítrico/administração & dosagem , Síndrome da Persistência do Padrão de Circulação Fetal/diagnóstico , Síndrome da Persistência do Padrão de Circulação Fetal/fisiopatologia , Resultado do Tratamento , Vasodilatadores/administração & dosagem
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