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Acquired methemoglobinemia
Abstract:
Cases of acquired methemoglobinemia have been identified with increasing frequency in Los Angeles during the last several years. Among 18 patients, both infants and adults, the most commonly incriminated agent was silver nitrate used for topical antibacterial prophylaxis of burn wounds. One burned child died from overwhelming septicemia complicated by hypoxia with a methemoglobin level of 5.4 grams per dl. Other causative factors included nitrate-rich vegetables used in early infancy, additives in ethnic foods, and prescribed and overdosed drugs. Discontinuation of the precipitating agent and methylene blue therapy were usually followed by prompt improvement. In burned patients treated with silver nitrate, careful regular monitoring of serum methemoglobin levels and early initiation of specific therapy are mandatory.
Insights
Acquired methemoglobinemia is increasingly seen, often linked to silver nitrate burn treatments. Prompt discontinuation of the agent and methylene blue therapy are crucial for recovery.
Area of Science:
- Clinical Toxicology
- Pediatrics
- Dermatology
Background:
- Acquired methemoglobinemia cases are rising in Los Angeles.
- This condition affects both infants and adults.
Purpose of the Study:
- To identify common causes of acquired methemoglobinemia.
- To highlight the role of silver nitrate in burn wound care.
Main Methods:
- Retrospective review of 18 patients with acquired methemoglobinemia.
- Analysis of causative agents, including topical agents, diet, and medications.
Main Results:
- Silver nitrate for burn prophylaxis was the most frequent cause.
- Other causes included nitrate-rich vegetables, food additives, and drug overdoses.
- One pediatric case resulted in fatal septicemia with hypoxia.
Conclusions:
- Silver nitrate use in burn patients requires vigilant methemoglobin monitoring.
- Early intervention with methylene blue is effective for methemoglobinemia treatment.