sodium-bicarbonate and Methemoglobinemia

Phenazopyridine (Pyridium) is a commonly used urinary tract analgesic. It has been associated with yellow skin discoloration, hemolytic anemia, methemoglobinemia, and acute renal failure, especially in patients with preexisting kidney disease. We report a 17-year-old female with vertically transmitted human immunodeficiency virus (HIV) infection, presenting with acute renal failure and methemoglobinemia following a suicidal attempt with a single 1,200 mg ingestion of Pyridium. She had no prior evidence of HIV nephropathy. The patient had a progressive nonoliguric renal failure on the 3rd day following the ingestion. She was treated with N-acetylcysteine, intravenous carnitine, and alkalinization of the urine. Her kidney biopsy revealed acute tubular necrosis with no glomerular changes. After 7 days of conservative management, she was discharged home with normal kidney function. To our knowledge, this is the second smallest amount of Pyridium overdose resulting in acute renal failure with no previous history of kidney disease.

Topics: Acetylcysteine; Acute Kidney Injury; Adolescent; Carnitine; Female; HIV Infections; Humans; Infectious Disease Transmission, Vertical; Methemoglobinemia; Phenazopyridine; Sodium Bicarbonate; Suicide, Attempted; Treatment Outcome

Acute aluminum phosphide (AlP) poisoning is one of the most common causes of acute pesticide poisoning in Iran. Hydrogen phosphide or phosphine gas is produced following reaction of AlP with water even at ambient humidity. Methemoglobinemia is a rare finding following phosphine poisoning. In this paper, two cases of fatal AlP poisoning complicated by methemoglobinemia are reported.. Two patients presented following suicidal ingestion of AlP tablets. In the Emergency Department (ED), they received gastric lavage with sodium bicarbonate and potassium permanganate. Both of them received supportive care. In each case, hematuria and hemolysis were significant events. The patients also showed a decrease in O(2) saturation in spite of high FIO(2). Methemoglobin levels of 40% and 30% were detected by co-oximetry. Neither patient responded to treatment (ascorbic acid in one case, methylene blue in the other). Both patients died due to systemic effects of phosphine poisoning.. Hemolysis and methemoglobinemia may complicate the course of phosphine poisoning that seems resistant to methylene blue and ascorbic acid. Therefore, other treatments including hyperbaric oxygen therapy and exchange blood transfusion should be considered.

Topics: Adult; Aluminum Compounds; Antidotes; Ascorbic Acid; Calcium Gluconate; Fatal Outcome; Fluid Therapy; Humans; Magnesium Sulfate; Male; Methemoglobinemia; Methylene Blue; Middle Aged; Pesticides; Phosphines; Sodium Bicarbonate; Suicide, Attempted

We report a case of systemic toxicity induced by indoxacarb, an oxadiazine insecticide. Previous reports have suggested the occurrence of methemoglobinemia after indoxacarb ingestion, but no case of indoxacarb-induced systemic toxicity, such as acute renal failure, has been reported thus far.. A 71-year-old woman presented with indoxacarb poisoning, resulting in methemoglobinemia and acute renal failure. The methemoglobinemia improved after methylene blue administration, but rapidly progressive acute renal failure occurred 7 h after admission. She was treated with continuous veno-venous hemofiltration and intravenous sodium bicarbonate and recovered successfully.. Ingestion of indoxacarb may produce not only methemoglobinemia, but also systemic toxicities like acute renal failure, which can be successfully treated with aggressive therapy such as continuous veno-venous hemofiltration. Physicians should be alert to acute renal failure as a possible complication of indoxacarb ingestion, and treat it accordingly.

Topics: Acute Kidney Injury; Aged; Female; Hemofiltration; Humans; Injections, Intravenous; Insecticides; Methemoglobinemia; Oxazines; Poisoning; Sodium Bicarbonate; Suicide, Attempted; Treatment Outcome

An 11-year-old, spayed female Dalmatian was presented with suspected acetaminophen toxicosis. The dog was severely depressed. Methemoglobinemia, facial edema, and hemoglobinuria responded to treatment with intravenous fluids, N-acetylcysteine, ascorbic acid, and sodium bicarbonate. There was no clinical evidence of hepatic damage typical of acetaminophen toxicity in the dog.

Topics: Acetaminophen; Acetylcysteine; Analgesics, Non-Narcotic; Animals; Ascorbic Acid; Dog Diseases; Dogs; Emergency Treatment; Female; Fluid Therapy; Free Radical Scavengers; Liver; Methemoglobinemia; Sodium Bicarbonate; Treatment Outcome

Methemoglobinemia may occur after the administration of various drugs, including some local anesthetics. We report a patient with chronic renal failure and ischemic heart disease who developed clinically significant methemoglobinemia after an axillary block with bupivacaine and additional injection of lidocaine in the operative field. Although the two local anesthetics usually do not cause methemoglobinemia, we suspect that the displacement of lidocaine from protein binding by bupivacaine, in combination with metabolic acidosis and treatment with other oxidants, was the reason for the development of methemoglobinemia.

Topics: Acidosis; Alkalies; Anesthetics, Local; Antidotes; Axilla; Bupivacaine; Drug Interactions; Female; Humans; Intraoperative Care; Kidney Failure, Chronic; Lidocaine; Methemoglobinemia; Methylene Blue; Middle Aged; Myocardial Ischemia; Nerve Block; Oxidants; Protein Binding; Sodium Bicarbonate

Reports of acute toxicity following sulfasalazine ingestion are rare. A case of an acute ingestion of sulfasalazine 50 g and paracetamol 50 g resulting in severe lactic acidosis, seizures, coagulopathy, hyperglycemia, ketosis, and methemoglobinemia is reported. Despite the ingestion of a large amount of paracetamol with serum paracetamol 5486 nmol/L (844 mg/L), significant hepatotoxicity did not occur. The patient recovered fully following administration of intravenous N-acetylcysteine, methylene blue, sodium bicarbonate, and supportive therapy.

Topics: Acetaminophen; Acetylcysteine; Acidosis, Lactic; Acute Disease; Adult; Anti-Inflammatory Agents; Blood Coagulation Disorders; Blood Platelets; Drug Combinations; Drug Overdose; Humans; Hyperglycemia; Infusions, Intravenous; Male; Methemoglobinemia; Methylene Blue; Partial Thromboplastin Time; Sodium Bicarbonate; Suicide, Attempted; Sulfasalazine