Whole bowel irrigation in dapsone intoxication with persistent methemoglobinemia - 25/11/20
, Nicolás Gemelli, MD, Maria Paula Cordero, MD, Cecilia Barrios, MD, Daniel Pina, MDAbstract |
Dapsone intoxication can be a life-threatening condition due its enterohepatic recirculation pharmacokinetics, and therefore, persistent methemoglobinemia development. We describe a case of a 17-year-old girl who was admitted 4 h after ingesting 5 g of dapsone. She presented methemoglobinemia (39%) and showed clinical signs of toxicity (cyanosis and altered mental status) despite mechanical ventilation. Multiple activated charcoal dosis and methylene blue infusions were performed. Notwithstanding initial improvement, a pattern of peaks and valleys was observed in serial methemoglobinemia measurements, with cyclic states of hypoxemia. On account of enterohepatic recirculation pharmacokinetics, clearance was enhanced by whole bowel irrigation. After 7 days of hospitalization, she was discharged in good general condition.
Il testo completo di questo articolo è disponibile in PDF.Highlights |
• | Dapsone undergoes enterohepatic recirculation and, as a result, has a long half-life (30 h). |
• | Methemoglobinemia due to dapsone intoxication presents worse clinical course. |
• | Rebound in methemoglobin concentration with recurrent hypoxemia is observed. |
• | When persistent methemoglobinemia whole bowel irrigation is possible to be considered. |
Keywords : Methemoglobin, Dapsone, Enterohepatic circulation, Poisoning
Mappa
Vol 38 - N° 10
P. 2246.e1-2246.e2 - ottobre 2020 Ritorno al numeroBenvenuto su EM|consulte, il riferimento dei professionisti della salute.
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