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Published on: March 14, 2017
Toxic metabolic encephalopathy after parathyroidectomy with methylene blue localization
Swapna S Kartha1, Chris E Chacko, Jeffrey M Bumpous
1University of Louisville School of Medicine, Department of Surgery, Division of Otolaryngology, Louisville, Kentucky, USA.
Objective:
To determine the correlation between methylene blue use and toxic metabolic encephalopathy in patients undergoing surgery for primary hyperparathyroidism.
Study Design And Setting:
A retrospective study of 193 patients was performed to collect demographic, perioperative, and postoperative data. Patients were divided into two groups: Group A (postoperative neurological sequelae) and Group B (no neurological sequelae). All data points were compared between the groups.
Results:
Twelve of 193 patients were placed in Group A; 181 patients were placed in Group B. Ten patients in Group A were female, and 10 patients were older than 60 years. Of the patients in Group A, 100% were taking a serotonin reuptake inhibitor (SRI). In Group B, 8.8% of patients were taking an SRI.
Conclusion:
All the patients who experienced transient neurological events were taking an SRI. A correlation can be made between methylene blue infusion and SRI usage.
Significance:
Patients taking SRIs may represent a high-risk group for postoperative neurological events when methylene blue is utilized.
Related Concept Videos
01:29Hepatic Encephalopathy
01:26Toxic Reactions: Overview
Toxicity falls into two primary categories: local and systemic.
Local toxicity appears at the exposure site, such as protein denaturation caused by caustic substances.
In contrast, systemic toxicity requires the toxic agent's absorption and distribution,...