A.A. Abildayeva ¹, B.B. Alieva ¹, A.A. Arynov ¹, B.T. Ongarbayev ¹, G.B. Raev ¹, S.N. Madaliyev ¹

1. «Kazakh Research Institute of Oncology and Radiology» JSC, Аlmaty, the Republic of Kazakhstan

DOI: https://www.doi.org/10.52532/2663-4864-2023-3-69-16-21

UDC: 616-006-052:153.963.43

Year: 2023 issure: 69 number: 3 pages: 16-21

Download PDF:

ABSTRACT

Relevance: Methemoglobinemia is a serious disease characterized by impaired oxygen binding to iron in hemoglobin, followed by impaired oxygen delivery to body tissues. Various drugs, including antacids containing benzocaine, can cause acquired methemoglobinemia. The presented clinical cases describe methemoglobinemia that arose in connection with the use of the antacid Almagel A in a 32-year-old woman who underwent surgery on the laryngopharynx, suffering from T3NxM0 St III hypopharyngeal cancer and in a 45-year-old woman diagnosed with cancer of the left kidney St I. Condition after resection of the left kidneys.
The study aimed to describe clinical cases of acquired methemoglobinemia induced by Almagel A (antacid), widely used in post-antitumor therapy treatment of cancer patients with digestive system diseases.
Methods: We present clinical cases of methemoglobinemia in patients (32 and 45 years old) hospitalized at JSC “Kazakh Research Institute of Oncology and Radiology.” Complaints, anamnesis of the disease, clinical picture, and clinical, laboratory, and instrumental test results were analyzed retrospectively.
Results: This article reports on the clinical picture of our patients, discusses the causes and mechanisms of possible poisoning, and reviews the latest recommendations for the treatment of methemoglobinemia. Treatment with intravenous methylene blue led to a rapid improvement in the patient’s respiratory status.
Conclusion: Acquired methemoglobinemia is an acute condition that most often results from poisoning with certain drugs and compounds, which can be fatal. These clinical cases demonstrate the difficulties of diagnosing methemoglobinemia, highlight the value of taking anamnestic data, studying the acid-base state and blood gases, and the effectiveness of using methylene blue as an antidote drug in treatment.
Keywords: Methemoglobinemia, methylene blue, hypoxia, cyanosis, acrocyanosis.

List of sources used:

1. Iolascon A., Bianchi P., Andolfo I., Russo R., Barcellini W., Fermo E., Toldi G., Ghirardello S., Rees D., Van Wijk R., Kattamis A., Gallagher P.G., Roy N., Taher A., Mohty R., Kulozik A., De Franceschi L., Gambale A., De Montalembert M., Luca Forni G., Harteveld C.L., Prchal J. Recommendations for diagnosis and treatment of methemoglobinemia // Am. J. Hematol. – 2021. – Vol. 2021 – P. 1-13. https://doi.org/10.1002/ajh.26340
2. Nappe T.M., Pacelli A.M., Katz K. An atypical case of methemoglobinemia due to self-administered Benzocaine // Case Rep. Emerg. Med. – 2015. – Vol. 2015. – P. 1-4. http://dx.doi.org/10.1155/2015/670979
3. Sewell C.R., Rivey M.P. A case report of Benzocaine-Induced Methemoglobinemia // J. Pharm. Pract. – 2018. – Vol. 31(5). – P. 507-509. https://doi.org/10.1177/0897190017723211
4. Emel’janova Je.A., Asekritova A.S., Mojakunov D.A. Metgemoglobinemija, inducirovannaja almagelem A // Sovrem. Probl. Nauki i Obraz. – 2021. – №6 [Emelyanova E.A., Asekritova A.S., Moyakunov D.A. Methemoglobinemia induced by almagel A // Modern Problems of Science and Education. – 2021. – No. 6 (in Russ.)]. https://doi.org/10.17513/spno.31340
5. Ivek I., Knotek T., Ivicic T., Rubinic B., Bajlo P., Hamzic J. Methemoglobinemia – a case report and literature review // Acta Clin. Croat. – 2022. – Vol. 61. – P. 93-98. https://doi.org/10.20471/acc.2022.61.s1.16