ascorbic-acid and Cyanosis

Topics: Ascorbic Acid; Cyanosis; Daucus carota; Diagnosis, Differential; Dyspnea; Emergency Treatment; Humans; Infant; Male; Methemoglobinemia; Nitrites; Severity of Illness Index; Shock, Septic; Tunisia

A 14-year-old boy of Asian origin presented with a history of bluish discolouration of the finger and toenail bed with associated mild fatiguability on exertion since early childhood. Clinical examination revealed bilaterally symmetric uniform central cyanosis with no associated clubbing. Cardiovascular and respiratory system examination was normal. Pulse oximetry revealed an oxygen saturation of 87% in all four limbs. Transthoracic and transoesophageal echocardiography showed no evidence of shunt lesions. In view of the past diagnosis of pulmonary arteriovenous fistulae made at 4 years of age, a repeat cardiac catheterisation study was done, which revealed no shunt at any level. Interestingly, arterial oxygen tension of the chocolate-brown blood was normal in all the samples, suggesting the possibility of methaemoglobinaemia. Co-oximetry revealed methaemoglobin levels of 36%, confirming the diagnosis. Secondary causes were ruled out. The family was counselled about the hereditary nature of the condition.

Topics: Adolescent; Antioxidants; Ascorbic Acid; Blood Gas Analysis; Cardiac Catheterization; Color; Cyanosis; Directive Counseling; Fatigue; Genetic Testing; Humans; Male; Methemoglobin; Methemoglobinemia; Nails, Malformed; Oximetry; Treatment Outcome

Methemoglobin (MetHb) is an oxidized form of hemoglobin. It is a poor transporter of oxygen and is unable to deliver oxygen to the tissue. Globally, drug & toxin induced methemoglobinemia is more common as compared with the congenital form. Methemoglobinemia caused by paint thinner intoxication is rare. Methylene blue is well established as the first-line therapy for severe methemoglobinemia.. A 25-year old man was brought to the Emergency Department after accidental consumption of paint thinner. On clinical examination, he had cyanosis and there were discrepancies in his pulse oximetry and arterial blood gas (ABG) analysis results. With this clue and supporting laboratory investigations, the diagnosis of toxin-induced methemoglobinemia was made. Due to the unavailability of methylene blue, alternative treatment with high-dose vitamin C was attempted, to which the patient responded. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The role of vitamin C in the treatment of methemoglobinemia has not been well established, with only a few published case reports. This patient had severe methemoglobinemia, with MetHb of 46.4%, which responded dramatically to vitamin C therapy, with no side effects. This case shows that high-dose vitamin C is safe and has the potential to be an effective alternative for the treatment of severe methemoglobinemia. In the presence of cyanosis, mismatch of pulse-oximetry and ABG-analysis are the key for the physician to suspect methemoglobinemia.

Topics: Adult; Antioxidants; Ascorbic Acid; Blood Gas Analysis; Cyanosis; Humans; Male; Methemoglobinemia; Methylene Blue; Oxygen; Paint

Topics: Administration, Topical; Anesthetics, Local; Ascorbic Acid; Benzocaine; Cyanosis; Diagnosis, Differential; Humans; Infant, Newborn; Male; Methemoglobinemia; Perineum

Topics: Anesthetics, Local; Antioxidants; Ascorbic Acid; Circumcision, Male; Cyanosis; Humans; Infant; Male; Methemoglobinemia; Prilocaine

Methemoglobinemia is characterized by varying degrees of cyanosis due to increased hemoglobin concentrations containing oxidized iron. Prilocaine is a widely used local anesthetic and can cause methemoglobinemia in infants even in therapeutic doses. We present two female infants (younger than 2 months) who developed severe cyanosis after transcatheter pulmonary balloon valvuloplasty and were diagnosed with toxic methemoglobinemia. Both infants were anesthetized with local prilocaine application before balloon valvuloplasty. Methemoglobin levels of the patients were measured as 49.6% and 37.7%, respectively. Both were successfully treated with intravenous methylene blue and ascorbic acid.

Topics: Anesthetics, Local; Ascorbic Acid; Catheterization; Cyanosis; Female; Humans; Infant; Methemoglobinemia; Methylene Blue; Prilocaine; Treatment Outcome

Topics: Anesthetics, Local; Ascorbic Acid; Circumcision, Male; Cyanosis; Humans; Infant; Male; Methemoglobinemia; Postoperative Complications; Prilocaine; Reducing Agents

Topics: Aged; Ascorbic Acid; Cyanosis; Dermatitis Herpetiformis; Dyspnea; Female; Humans; Oxygen; Sulfones

Adults with cyanotic congenital heart disease (CCHD) have been shown to have endothelial dysfunction in the forearm resistance vessels as assessed with venous occlusion plethysmography. Whether these abnormalities are confined to the microvasculature or reflect generalized endothelial dysfunction remain unknown. We used high-resolution ultrasound to compare flow responses and endothelial-dependent flow-mediated dilation (FMD) in the brachial artery of 13 adult patients with CCHD and 14 healthy controls. High-dose vitamin C was infused to evaluate the possible role of reactive oxygen species on endothelial vasomotor function. FMD was measured both prior to and after vitamin C infusion. Sublingual glyceryl nitrate was given to assess endothelium-independent responses. FMD did not differ among patients with CCHD and controls either before (6.2 +/- 4.1, 5.1 +/- 2.6%, p = 0.44) or after (5.1 +/- 2.8, 5.2 +/- 3.1%, p = 0.90) vitamin C infusion. Endothelium-independent vasodilatation was similar in both groups (14.3 +/- 3.7, 13.2 +/- 4.4%). There were no differences in baseline flow or in measures of reactive hyperemia. Adults with CCHD appear to have preserved endothelial function in their conduit arteries. This suggests that these patients are not at an increased risk of premature atherosclerotic cardiovascular events.

Topics: Adult; Ascorbic Acid; Blood Flow Velocity; Brachial Artery; Case-Control Studies; Cyanosis; Eisenmenger Complex; Endothelium, Vascular; Female; Heart Defects, Congenital; Humans; Male; Microcirculation; Middle Aged; Nitroglycerin; Oxidative Stress; Statistics, Nonparametric; Ultrasonography

Methemoglobinemia, although rare, must be considered in surgical patients presenting with acute respiratory distress and cyanosis. We report two cases of methemoglobinemia in patients undergoing aortic reconstruction. The first patient developed methemoglobinemia while on a nitroglycerin infusion, and the second after receiving benzocaine spray before intubation. Both patients were treated with methylene blue and ascorbic acid, with resolution of their hypoxia and cyanosis. The pathophysiology, etiology, diagnosis, and treatment of methemoglobinemia are reviewed.

Topics: Aged; Antioxidants; Ascorbic Acid; Blood Vessel Prosthesis Implantation; Cyanosis; Enzyme Inhibitors; Female; Humans; Methemoglobinemia; Methylene Blue; Middle Aged; Postoperative Complications; Treatment Outcome

Topics: Adult; Ascorbic Acid; Cyanosis; Humans; Male; Methemoglobinemia; Oxygen

Methylene blue is used to check tubal patency during laparoscopy. A case of methemoglobinemia which was induced by methylene blue is presented. Methemoglobinemia is usually treated with methylene blue; however, in patients with glucose-6-phosphate dehydrogenase deficiency, methylene blue can induce methemoglobinemia.

Topics: Adult; Ascorbic Acid; Coloring Agents; Cyanosis; Fallopian Tube Patency Tests; Female; Glucosephosphate Dehydrogenase Deficiency; Humans; Infertility, Female; Injections, Intravenous; Laparoscopy; Methemoglobinemia; Methylene Blue

Topics: Acidosis; Ascorbic Acid; Child, Preschool; Cyanosis; Diagnosis, Differential; Fluid Therapy; Humans; Infant, Newborn; Male; Methemoglobinemia; Methylene Blue

Topics: Ascorbic Acid; Blood Protein Electrophoresis; Cyanosis; Dihydrolipoamide Dehydrogenase; Erythrocytes; Genes, Recessive; Homozygote; Humans; Infant, Newborn; Male; Methemoglobinemia; Pedigree; Prognosis

Topics: Ascorbic Acid; Cyanosis; Dihydrolipoamide Dehydrogenase; Erythrocytes; Female; Heterozygote; Humans; Intestines; Kinetics; Metabolism, Inborn Errors; Methemoglobin; Methemoglobinemia; Middle Aged; NAD; Neomycin

Topics: Anesthesia, Inhalation; Ascorbic Acid; Blood Gas Analysis; Cyanosis; Female; Hemoglobins; Humans; Methemoglobin; Methemoglobinemia; Methylene Blue; Middle Aged; Nitrous Oxide; Spectrum Analysis; Thiopental; Tubocurarine

Topics: Accidents, Occupational; Ascorbic Acid; Coma; Cyanosis; Environmental Exposure; Euphoria; Gastrointestinal Diseases; Humans; Hydrogen Sulfide; Nausea; Occupational Diseases; Oxygen Inhalation Therapy; Petroleum; Respiratory Tract Diseases; Tachycardia

Topics: Acetanilides; Ascorbic Acid; Cyanosis; Drug Industry; Humans; Methemoglobinemia; Methylene Blue; Occupational Diseases; Poisoning

Topics: Ascorbic Acid; Child, Preschool; Cyanosis; Dapsone; Dyspnea; Female; Heart Rate; Hemoglobins; Humans; Hyperkinesis; Infant; Leukocyte Count; Male; Methemoglobinemia; Methylene Blue; Vomiting

Topics: Ascorbic Acid; Benzocaine; Clinical Laboratory Techniques; Cyanosis; Drug Therapy; Humans; Infant; Laboratories; Methemoglobinemia; Methylene Blue; Suppositories; Toxicology

Topics: Ascorbic Acid; Blood Protein Electrophoresis; Child; Cyanosis; Genetics, Medical; Heart Diseases; Hemoglobins; Humans; Infant; Infant, Newborn; Methemoglobin; Methemoglobinemia; Methylene Blue; Oxidoreductases; Pathology; Spectrophotometry

Topics: Ascorbic Acid; Cyanosis; Diagnosis, Differential; Electrocardiography; Genetics, Medical; Humans; Methemoglobinemia

Topics: Ascorbic Acid; Cyanosis; Diagnosis, Differential; Dihydrolipoamide Dehydrogenase; Humans; Metabolic Diseases; Methemoglobinemia

Topics: Ascorbic Acid; Cyanosis; Erythrocytes; Humans; Methemoglobinemia; Methylene Blue; Vitamins