On questioning, there was an alleged history of consumption of unknown quantity of thinner. The patient was a chronic alcoholic who had allegedly consumed thinner as no alcohol was available to him that day.
On examination, he was unconscious, not responding to deep painful stimuli and severely cyanosed with mottled skin.
Blood withdrawn for investigations was chocolate brown in color. As there was no improvement in the cyanosis, another dose of MB mg IV was repeated after half an hour. Methemoglobin levels came out to be The patient had a cardiac arrest within 3 h of arrival in the hospital and could not be revived. Etiologies of methemoglobinemia can be broadly characterized as genetic or acquired, with the latter being much more common than the former.
The majority of methemoglobinemia cases result from exposure to exogenous oxidizing agents [ Table 1 ]. These products mainly contain various concentrations of toxic aromatic hydrocarbons benzene, toluene and xylene or halogenated hydrocarbons carbon tetrachloride, methylcellulose and trichloroethylene along with P naphtha.
Selected agents capable of inducing methemoglobinemia[ 2 ]. Direct observation may reveal blood that is chocolate brown in color. The presence of definite cyanosis in an individual with little or no dysponea and a normal PaO 2 level may also suggest the diagnosis. Because of the spectral properties of methemoglobin, oxygen desaturation recorded by pulse oximetry may not correlate well with the actual percentage of methemoglobin in the blood.
Clinical symptomatology varies depending on the methemoglobin concentration. Cyanosis begins to develop at levels greater than 1.
However, the onset of symptoms does not always correlate with particular methemoglobin concentrations. Treatment of methemoglobinemia is dependent on the aetiology and time course. For acute methemoglobinemia due to drug exposure, treatment includes discontinuation of the offending agent.
If MB therapy is ineffective and life-threatening shock is imminent, exchange transfusion should be initiated. Ascorbic acid, part of the minor reduction pathway of methemoglobin, may be useful in patients in whom MB therapy is contraindicated.
Additionally, activated charcoal may be useful in instances of dapsone-induced methemoglobinemia[ 3 ] N -acetylcysteine, a mucolytic agent, is believed to restore intracellular glutathione and may be capable of serving as a glutathione substitute capable of directly reducing oxidized agents.
Acquired methemoglobinemia has been reported to be due to accidental,[ 8 , 9 ] suicidal[ 5 , 10 ] or occupational causes,[ 11 ] many of the patients being children. On literature search, case reports on thinner intoxication as a cause of methemoglobinemia were found to be few and far in between.
The present cases are among the very few that highlight methemoglobinemia as a manifestation of thinner intoxication in adults.
Collison reported the death of a year-old Caucasian male whose autopsy revealed thinner in his stomach. The child was managed conservatively and had a complete recovery. Acute methemoglobinemia constitutes a medical emergency and may result in significant mortality inspite of treatment, if it is severe. One way is to use caution. Store solutions such as household cleaners, kerosene, and paint where children can't get to them.
When using these products, make su Full Answer. Q Does paint thinner poisoning affect children differently than adults? For example, while adults may cough or choke after swallowing a hydrocarbon-containi Q How do I care for someone following paint thinner poisoning? A Diana Meeks answered. These treatments may include oxygen therapy and medications.
Does paint thinner poisoning affect children differently than adults? Jeanne Morrison, PhD. About half the cases of paint thinner poisoning involve young children, and certain factors may infl Is paint thinner poisoning preventable? Paint thinner poisoning can be prevented in several ways. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.
The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The person may receive:. How well a person does depends on the amount of poison swallowed and how quickly treatment was received.
The faster a person gets medical help, the better the chance for recovery. Swallowing such poisons can have severe effects on many parts of the body.
Burns in the airway or gastrointestinal tract can lead to tissue death. This may result in infection, shock and death, even several months after substance was swallowed.
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