Cyanosis in children is most often caused by pulmonary disease, or cyanotic heart disease but is rarely caused by hematological problems such as methemoglobinemia and sulfhemoglobinemia. Abnormal hemoglobins with a reduced oxygen affinity are an exceptionally uncommon cause of cyanosis in children. Hemoglobin-M (Hb-M) is rapidly auto-oxidized into the met-form resulting in the loss of its O2-binding ability. This hemoglobinopathy is inherited in an autosomal dominant pattern and is characterized by marked cyanosis. Hb-M affects the anesthetic management because of the anomalous absorption spectrum of Hb-M in standard pulse oximetry. Sufficient O2 delivery should be maintained by keeping a high FiO2 and intermittently checking the O2 delivery state using arterial blood gas analysis. We reported our experience of the anesthetic management of a patient with hemoglobin M.
Absorption ; Blood Gas Analysis ; Child ; Cyanosis ; Heart Diseases ; Hemoglobin M ; Hemoglobinopathies ; Hemoglobins, Abnormal ; Humans ; Lung Diseases ; Methemoglobin ; Methemoglobinemia ; Oximetry ; Oxygen ; Sulfhemoglobinemia

Dapsone toxicity is evidenced by varying clinical pictures ranging from deep cyanosis in an otherwise alert normal appearing individual to restlessness, dyspnea, extensive hemolytic anemia, methemoglobinemia, sulfhemoglobinemia and serious central nervous system dysfunction. We experienced a case of acute massive dapsone intoxication in 34 years old man due to voluntary ingestion of 25g of this drug as a suicide attempt. A severe methemoglobinemia developed, accompanied by nausea, vomiting, intense cyanosis, headache, and dyspnea. Subsequently moderate hemolytic anemia observed. The patient recovered completely after intensive treatment with methylene blue, activated charcoal hemoperfusion, oral charcoal ingestion, steroid, and conservative treatment. Methylene blue was given by continuous intravenous infusion in order to avoid overdosage. We herein report a case of the acute hemolytic anemia and severe methemoglobinemia induced by massive dapsone intoxication with a review of the literature.
Adult ; Anemia, Hemolytic* ; Central Nervous System ; Charcoal ; Cyanosis ; Dapsone* ; Dyspnea ; Eating ; Headache ; Hemoperfusion ; Humans ; Infusions, Intravenous ; Methemoglobinemia* ; Methylene Blue ; Nausea ; Psychomotor Agitation ; Suicide ; Sulfhemoglobinemia ; Vomiting

Pendipronil(R) overdose is uncommon in Korea. Pendipronil(R) is a selective herbicide used to control most annual grasses and certain broadleaf weeds in field corn, potatoes, rice, etc. and is the substance including pendimethalin and propanil. Pendimethalin is slightly to practically nontoxic by ingestion but may be mildly to moderately irritating to the linings of the mouth, nose, throat, and lungs. Propanil toxicity is evidenced by varying clinical pictures ranging from deep cyanosis in an otherwise alert normal appearing individual to restlessness, dyspnea, extensive hemolytic anemia, methemoglobinemia, sulfhemoglobinemia and serious central nervous system dysfunction. For the treatment of methemoglobinemia, gastric lavage, activated charcoal, methylene blue and exchange transfusion should be used. We experienced a case of acute massive Pendipronil(R) intoxication in 31 years old woman due to voluntary ingestion of 48g of this drug as a suicide attempt. A moderate methemoglobinemia developed, accompanied by drowsy mental status, nausea, vomiting, headache, intensive cyanosis. The patient recovered completely after intravenous methylene blue injection and cellulose coated hemoperfusion charcoal (Adsorba 300C(R)) and conservative treatment.
Adult ; Anemia, Hemolytic ; Cellulose ; Central Nervous System ; Charcoal ; Cyanosis ; Dyspnea ; Eating ; Female ; Gastric Lavage ; Headache ; Hemoperfusion* ; Humans ; Korea ; Lung ; Methemoglobinemia ; Methylene Blue* ; Mouth ; Nausea ; Nose ; Pharynx ; Poaceae ; Poisoning* ; Propanil ; Psychomotor Agitation ; Solanum tuberosum ; Suicide ; Sulfhemoglobinemia ; Vomiting ; Zea mays