faust
lost among the stars
- Jan 26, 2020
- 3,138
Two cases from "Reactions Weekly"
Methaemoglobinaemia following suicide attempt: case report. |
A 29-year-old man developed methaemoglobinaemia following sodium nitrite overdose in a suicide attempt. The man, in an attempt to suicide, intentionally ingested 20-22g of sodium nitrite. He called emergency response, 5 minutes later. He was found obtunded by the paramedics; however, following room air ventilation he was able to describe events. Subsequently, he became more obtunded and seized. He was intubated. Upon arrival, his HR was 106 beats/minute, BP was 113/57 mmHg, RR was 18 breaths/minute, and oxygenation saturation 86%. Severe cyanosis was revealed on physical examination. He was immediately administered methylene blue. A minute after methylene blue administration, arterial laboratory studies drawn revealed methaemoglobin concentration 91%, lactic acid 11.5 mmol/L and pO2 109 mmHg. He was given activated charcoal. One hour post the methylene blue administration, repeat methaemoglobin concentration was 54%. One hour post the first dose of methylene blue, he was given an additional dose of methylene blue and repeat methaemoglobin concentration 24 minutes later was 35%. As his haemoglobin was 11.6mg/dL, he was given 2 units of packed RBCs to enhance oxygen carrying capacity. Subsequent methaemoglobin concentration was 6% and it was undetectable approximately 24 hours post-ingestion. On hospital day 2 neurologically intact, he was transferred to the psychiatry service.
Author comment: "To describe successful therapy in a patient with severe sodium nitrite poisoning after intentional ingestion who recovered completely within 24 hours." "Severe methaemoglobinemia from intentional sodium nitrite poisoning can be effectively resuscitated using an aggressive approach with decontamination, methylene blue, and blood transfusion."
From this report we can see that a person fully recovered in 24 hours, this proves the safety of the method if some of you are afraid of any damage to body.
It was his choice to call emergency so I guess he was not ready or his SI was too strong at that moment
Methaemoglobinaemia and shock following a suicide attempt: case report. |
An 18-year-old man developed methaemoglobinaemia and shock following the ingestion of sodium nitrite in a suicide attempt. The man presented to the emergency department in an unconscious state 2 hours following the ingestion of an unknown amount of an unknown substance in a suicide attempt. Unconsciousness had been preceded by 8-10 episodes of watery vomiting. The culprit was later identified as sodium nitrite, since his family was involved in a dye industry. Upon physical examination, he appeared unconscious, collapsed, unresponsive and deeply cyanosed. He had no pulse, his BP could not be recorded, the periphery of his body was clumsy and cool, and he had a respiratory rate of 12 breaths/min. His pupils were sluggishly reactive to light and appeared bilaterally semi-dilated. Oxygen saturation was found to be 80% following which, his blood samples were urgently collected for further analyses. His blood was found to be chocolate brown. The man was initiated on vasopressor support with noradrenaline. Oxygen was passed through the blood sample collected; however, a change in colour was not observed. He was therefore moved to the ICU and put on a ventilator. Initial arterial blood gas analysis revealed the following: pH 7.26, partial pressure of oxygen (pO2) 533mm Hg, oxygen saturation (SpO2) 100%, partial pressure of carbon dioxide (pCO2) 27.4mm Hg, bicarbonate (HCO3) 12.1 mEq/L and methaemoglobin 77%. His BP and cyanosis showed no improvement in spite of complete ventilatory support. Laboratory profile revealed the following: haemoglobin 12.5 g/dL, platelet count 235000/mm3, leukocyte count 8750/ mm3, normal electrolyte concentrations, chest X-ray, urinalysis, echocardiogram, kidney and renal functions. ECG revealed sinus tachycardia. Methaemoglobinaemia and central cyanosis were thus attributed to poisoning from sodium nitrite dye. The man was administered methylene blue as an antidote. Two hours later, methaemoglobin levels reduced to 45%, with a subsequent improvement in BP and cyanosis. Two more doses of methylene blue were repeated at 4-hour intervals; he also received ascorbic acid for 2 days. Vasopressor support was gradually tapered off. He was weaned off ventilator support after 24 hours, when his BP, saturation gap, oxygen saturation and methaemoglobin normalised. Arterial blood gas analysis after 24 hours revealed the following: pH 7.43, pO2 91mm Hg, SpO2 97%, pCO2 33.6mm Hg, HCO3 21.9 mEq/L and methaemoglobin 0.7%. He was discharged on day-4 in a stable haemodynamic condition.
Author comment: "We herein report a case of acute methemoglobinemia with shock due suicidal ingestion of unknown quantity of sodium nitrite."
This person was presented to the hospital in an unconscious state, meaning that somebody saved him. It is crucial to have enough time to avoid being found. Another successful recovery and no sings of brain/body damage which means you won't ruin all your life if you are unsuccessful with this method.
Thus, it is always better to rest assured rather than panic about possible consequences.
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