Methemoglobinemija - prikaz slučaja i pregled literature
| Autor: | Ivek, Ida, Knotek, Tomislav, Ivičić, Toni, Rubinić, Barbara, Bajlo, Paola, Hamzić, Jasmin |
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| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | Acta clinica Croatica Volume 61. Issue Supplement 1 |
| ISSN: | 1333-9451 0353-9466 |
| Popis: | The objective of this case report is to present a patient with acquired methemoglobinemia due to poisoning of an unknown cause. A 55-year-old man was brought to the Emergency Department, University Hospital Center Zagreb, with an unwell appearance, cyanotic, restless, and presented with a quantitative consciousness disorder. An initial assessment showed decreased oxygen saturation (SpO2 85 [%]), while point-of-care arterial blood gas (ABG) analysis assessed normal partial pressure of oxygen (pO2). Severe lactic acidosis with a compensatory drop in partial pressure of carbon dioxide (pCO2) and high rates of methemoglobin were found. Supportive oxygen therapy and crystalloid solutions were administered, which resulted in rapid clinical recovery within 40 minutes of the initial assessment. Clinical recovery was accompanied by normalized ABG test results taken serially. Typical antidotes, methylene blue and vitamin C, were not administered due to rapid clinical improvement. Methemoglobinemia can be congenital (hereditary) or acquired (toxic). Both conditions are rarely seen in emergency departments, nevertheless, they should be approached properly since methemoglobinemia can be a severe, and fatal, condition. Methemoglobinemia symptoms are the results of inadequate oxygen transport. The diagnosis was confirmed by co-oximetry, while three clinical entities suspected methemoglobinemia: refractory hypoxia, “cyanosis-saturation gap“ and dark brown blood. This paper reports our patient’s clinical presentation, discusses the causes and mechanisms of possible poisoning, and reviews recent guidelines for methemoglobinemia management. Svrha ovog rada je prikaz slučaja pacijenta sa stečenom methemoglobinemijom uslijed trovanja nepoznatog uzroka. 55-godišnji muškarac zapuštenog izgleda dovežen je u Objedinjeni hitni bolnički prijem (OHBP ) Kliničkog bolničkog centra (KBC) Zagreb cijanotičan, nemiran i kvalitativno promijenjenog stanja svijesti. U inicijalnoj obradi nađena je snižena saturacija kisikom (SaO2 85[%]), dok je plinska analiza arterijske krvi ukazivala na zadovoljavajuće vrijednosti parcijalnog tlaka kisika. Nađena je teška laktacidoza s kompenzatorno sniženim parcijalnim tlakom ugljikovog dioksida, a zamijećen je i visok postotak methemoglobina. Na primijenjenu suportivnu oksigenoterapiju te terapiju kristaloidnim otopinama, pacijentovo se kliničko stanje rapidno oporavlja unutar četrdesetak minuta, što se prati i normalizacijom serijski evaluiranog acidobaznog statusa. S obzirom na povoljan klinički tijek, nije bilo potrebe za primjenom antidota – metilenskog modrila i vitamina C. Postoje urođena (genetska) i stečena (toksična) methemoglobinemija. Oba stanja se rijetko viđaju na hitnom prijemu, a stečena methemoglobinemija može biti životno ugrožavajuće stanje. Simptomi methemoglobinemije izravna su posljedica neadekvatnog transporta kisika. Dijagnoza se postavlja na temelju ko-oksimetrije, ali sama klinička sumnja može se postaviti na temelju sljedeća tri entiteta: refraktorne hipoksije, „cyanosis-saturation gap“ i smeđe boje krvi. U ovom radu osvrnut ćemo se na klinički tijek našeg pacijenta, dotaći se potencijalnih mehanizama trovanja i uzroka toksične methemoglobinemije te prikazati recentne preporuke za zbrinjavanje ovakvih slučaja. |
| Databáze: | OpenAIRE |
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