Methemoglobinemia treatment

Etteldorf, J.N. 1951. Methylene blue in the treatment of methemoglobinemia in premature infants caused by marking ink. J. Pediat. 38 24-27. 

Hematological Effects. A decrease in red blood cell counts was observed in persons exposed to a wood treatment liquid containing phenol, formaldehyde, and organic chlorohydrocarbons (Baj et al. 1994). Although only limited data were identified, hemolytic anemia and methemoglobinemia are considered to be well-documented complications of phenol poisoning in humans (ACGIH 1991). 

Intravenous injection of an 18.4 mg/kg dose of 1,2-diphenylhydrazine di(l not cause methemoglobinemia in rats, although methemoglobin was formed by an equimolar dose of aniline (Pfordte 1973) Information On methemoglobinemia in animals following treatment with... 

Ellenhorn MJ, Barceloux DG. 1988. Nitrates, nitrites, and methemoglobinemia. In Medical toxicology Diagnosis and treatment of human poisoning. New York, NY Elsevier, 844-851. 

Although dapsone (Avlosulfon) was once used in the treatment and prophylaxis of chloroquine-resistant P. falciparum malaria, the toxicities associated with its administration (e.g., agranulocytosis, methemoglobinemia, hemolytic anemia) have severely reduced its use. 

Smooth muscle relaxant activity. Tine-ture of the gland, administered to rabbits, was active on the bladder and intestine " . Toxic effect. Gum, administered orally to adults, was active. A case of methemoglobinemia occurred in a 5-week-old male infant, after administration of asafetida preparation to alleviate colic. Treatment was with intravenous methylene blue and the infant recovered . Tumor-promoting activity. Water extract of the dried oleoresin, administered externally to mice at a dose of 200 pL/animal, was active vs 7,12-dimethylbenz[a]anthra-cene and croton oil treatment ". ... 

Contraindications Hypersensitivity to methylene blue or any component of its formulation, glucose-6-phosphatedehydrogenase (G6PD) deficiency, intraspinal injection, severe renal insufficiency, treatment of methemoglobinemia in cyanide poisoning... 

Treatment Conventional antidote kit consists of nitrites to induce methemoglobinemia (which binds cyanide) and thiosulfate (which hastens conversion of cyanide to less toxic thiocyanate) a newer antidote kit (Cyanokit) consists of concentrated hydroxocobalamin, which directly converts cyanide into cyanocobalamin... 

Treatment of cyanide poisoning includes rapid administration of activated charcoal (although charcoal binds cyanide poorly, it can reduce absorption) and general supportive care. The conventional antidote kit available in the USA includes two forms of nitrite (amyl nitrite and sodium nitrite) and sodium thiosulfate. The nitrites induce methemoglobinemia, which binds to free CI T creating the less toxic cyanomethemoglobin thiosulfate is a cofactor in the enzymatic conversion of CN to the much less toxic thiocyanate (SCINT). Recently, the FDA approved a concentrated form of hydroxocobalamin, which is now available as the Cyanokit (EMD Pharmaceuticals, Durham, North Carolina). Hydroxocobalamin (one form of vitamin B12) combines rapidly with CN to form cyanocobalamin (another form of vitamin B12). 

Strauch B, Buch W, Grey W, et al. 1969. Successful treatment of methemoglobinemia secondary to silver nitrate therapy. New England Journal of Medicine 281 257-258. 

Dapsone Supportive treatment for the adverse effects of dapsone may be initiated with stomach wash and activated charcoal. Methylene blue could be given to treat methemoglobinemia, but this is not effective in patients with glucose-6-phosphate dehydrogenase deficiency. Infusion of human erythrocytes can be... 

Because of its intense yeUow color and low toxicity, riboflavin is widely used as a food color (E-fOf). It is also used in relatively high doses in the treatment of recessive famUial methemoglobinemia and some organic acidurias. 

---