Dapsone intoxication: Two case reports
Identifieur interne : 002C44 ( Main/Exploration ); précédent : 002C43; suivant : 002C45Dapsone intoxication: Two case reports
Auteurs : Duane G. Hansen [États-Unis] ; Kathryn R. Challoner [États-Unis] ; Dallas E. Smith [États-Unis]Source :
- Journal of Emergency Medicine [ 0736-4679 ] ; 1994.
English descriptors
- Teeft :
- Acute dapsone intoxication, Arterial blood, Arterial blood gases, Ascorbic acid, Blood pressure mmhg, Case report, Charcoal hemoperfusion, Clin toxicol, Dapsone, Dapsone intoxication, Dapsone overdose, Dapsone poisoning, Dehydrogenase deficiency, Dermatitis herpetiformis, Dos, Elimination half, Emergency medicine, Face mask, Gastric decontamination, Gastric lavage, Hemolytic anemia, Hours postingestion, Ingestion, Intensive care unit, Intoxication, Methemoglobin, Methemoglobin concentration, Methemoglobin concentrations, Methemoglobin levels, Methemoglobinemia, Methylene, Mmhg, Nasogastric tube, Overdose, Oxygen saturation, Plasma exchange, Pulse rate, Respiratory rate, Reticulocyte count, Serum methemoglobin level, Southern california, Symptomatic methemoglobinemia, Toxic metabolites, Vital signs.
Abstract
Abstract: Two patients with dapsone intoxication, an adult and a 16-month-old child, are reported. Both developed symptomatic methemoglobin concentrations, of 35% and 37%, respectively, and improved with intravenous methylene blue. Methemoglobin levels subsequently rose in both cases to 25% at 24 and 37 hours, respectively. The recurrence of elevated methemoglobin levels resulted from either continued absorption of dapsone or its toxic metabolite from the gastrointestinal tract. Both patients were begun on serial oral activated charcoal and the child received a second methylene blue treatment. During the intoxication, serum hemoglobin concentrations dropped 2 gm with an increase in the reticulocyte count. Review of 20 cases of dapsone overdose from the literature showed that the major toxic manifestations are methemoglobinemia and hemolysis. Delayed sulfhemoglobinemia, reported in only one case, resolved spontaneously. The treatment of dapsone intoxication is intravenous methylene blue for symptomatic methemoglobinemia, gastric decontamination, and early administration of serial oral activated charcoal. Hemolysis is mild but transfusions may be required for patients with a glucose-6-phosphate dehydrogenase deficiency.
Url:
DOI: 10.1016/0736-4679(94)90277-1
Affiliations:
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Le document en format XML
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<front><div type="abstract" xml:lang="en">Abstract: Two patients with dapsone intoxication, an adult and a 16-month-old child, are reported. Both developed symptomatic methemoglobin concentrations, of 35% and 37%, respectively, and improved with intravenous methylene blue. Methemoglobin levels subsequently rose in both cases to 25% at 24 and 37 hours, respectively. The recurrence of elevated methemoglobin levels resulted from either continued absorption of dapsone or its toxic metabolite from the gastrointestinal tract. Both patients were begun on serial oral activated charcoal and the child received a second methylene blue treatment. During the intoxication, serum hemoglobin concentrations dropped 2 gm with an increase in the reticulocyte count. Review of 20 cases of dapsone overdose from the literature showed that the major toxic manifestations are methemoglobinemia and hemolysis. Delayed sulfhemoglobinemia, reported in only one case, resolved spontaneously. The treatment of dapsone intoxication is intravenous methylene blue for symptomatic methemoglobinemia, gastric decontamination, and early administration of serial oral activated charcoal. Hemolysis is mild but transfusions may be required for patients with a glucose-6-phosphate dehydrogenase deficiency.</div>
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