Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3

methemoglobinemia Related Abstracts

3 Subcutan Isosulfan Blue Administration May Interfere with Pulse Oximetry

Authors: Esra Yuksel, Dilek Duman, Levent Yeniay, Sezgin Ulukaya


Sentinel lymph node biopsy (SLNB) is a minimal invasive technique with lower morbidity in axillary staging of breast cancer. Isosulfan blue stain is frequently used in SLNB and regarded as safe. The present case report aimed to report severe decrement in SpO2 following isosulfan blue administration, as well as skin and urine signs and inconsistency with clinical picture in a 67-year-old ,77 kg, ASA II female case that underwent SLNB under general anesthesia. Ten minutes after subcutaneous administration of 10 ml 1% isosulfan blue by the surgeons into the patient, who were hemodynamically stable, SpO2 first reduced to 87% from 99%, and then to 75% in minutes despite 100% oxygen support. Meanwhile, blood pressure and EtCO2 monitoring was unremarkable. After specifying that anesthesia device worked normally, airway pressure did not increase and the endotracheal tube has been placed accurately, the blood sample was taken from the patient for arterial gas analysis. A severe increase was thought in MetHb concentration since SpO2 persisted to be 75% although the concentration of inspired oxygen was 100%, and solution of 2500 mg ascorbic acid in 500 ml 5% Dextrose was given to the patient via intravenous route until the results of arterial blood gas were obtained. However, arterial blood gas results were as follows: pH: 7.54, PaCO2: 23.3 mmHg, PaO2: 281 mmHg, SaO2: %99, and MetHb: %2.7. Biochemical analysis revealed a blood MetHb concentration of 2%.However, since arterial blood gas parameters were good, hemodynamics of the patient was stable and methemoglobin concentration was not so high, the patient was extubated after surgery when she was relaxed, cooperated and had adequate respiration. Despite the absence of respiratory or neurological distress, SpO2 value was increased only up to 85% within 2 hours with 5 L/min oxygen support via face mask in the surgery room as the patient was extubated. At that time, the skin of particularly the upper part of her body has turned into blue, more remarkable on the face. The color of plasma of the blood taken from the patient for biochemical analysis was blue. The color of urine coming throughout the urinary catheter placed in intensive care unit was also blue. Twelve hours after 5 L/min. oxygen inhalation via a mask, the SpO2 reached to 90%. During monitoring in intensive care unit on the postoperative 1st day, facial color and urine color of the patient was still blue, SpO2 was 92%, and arterial blood gas levels were as follows: pH: 7.44, PaO2: 76.1 mmHg, PaCO2: 38.2 mmHg, SaO2: 99%, and MetHb 1%. During monitoring in clinic on the postoperative 2nd day, SpO2 was 95% without oxygen support and her facial and urine color turned into normal. The patient was discharged on the 3rd day without any problem.In conclusion, SLNB is a less invasive alternative to axillary dissection. However, false pulse oximeter reading due to pigment interference is a rare complication of this procedure. Arterial blood gas analysis should be used to confirm any fall in SpO2 reading during monitoring.

Keywords: isosulfan blue, pulse oximetry, SLNB, methemoglobinemia

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2 Utilization of Brachystegia Spiciformis Leaf Powder in the Removal of Nitrates from Wastewaters: An Equilibrium Study

Authors: Tichaona Nharingo, Isheanesu Hungwe, Munyaradzi Shumba


High levels of nitrates in drinking water present a potential risk to human health for it is responsible for methemoglobinemia in infants. It also gives rise to eutrophication of dams and rivers. It is, therefore, important to find ways of compating the increasing amount of nitrates in the environment. This study explored the bioremediation of nitrates from aqueous solution using Brachystegia spiciformis leaf powder (BSLP). The acid treated leaf powder was characterized using FTIR and SEM before and after nitrate biosorption and desorption experiments. Critical biosorption factors, pH, contact time and biomass dosage were optimized as 4, 30 minutes and 10 g/L respectively. The equilibrium data generated from the investigation of the effect of initial nitrate ion concentration fitted the isotherm models in the order Dudinin-Radushkevich < Halsey=Freundlich < Langmuir < Temkin model based on the correlation of determination (R2). The Freundlich’s adsorption intensity and Langmuir’s separation factors revealed the favorability of nitrate ion sorption onto BSLP biomass with maximum sorption capacity of 87.297 mg/g. About 95% of the adsorbed nitrate was removed from the biomass under alkaline conditions (pH 11) proving that the regeration of the biomass, critical in sorption-desorption cycles, was possible. It was concluded that the BSLP was a multifunctional group material characterised by both micropores and macropores that could be effectively utilised in nitrate ion removal from aqueous solutions.

Keywords: Adsorption, nitrates, methemoglobinemia, brachystegia spiciformis

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1 A Milky-White Stream Water Suitability for Drinking Purpose

Authors: Kassahun Tadesse, Megersa O. Dinka


Drinking water suitability study was conducted for a milky-white stream in remote areas of Ethiopia in order to understand its effect on human health. Water samples were taken from the water source and physicochemical properties were analyzed based on standard methods. The mean values of pH, total dissolved solids, sodium, magnesium, potassium, manganese, chloride, boron, and fluoride were within maximum permissible limits set for health. Whereas turbidity, calcium, irons, hardness, alkalinity, nitrate, and sulfate contents were above the limits. The water is very hard water due to high calcium content. High sulfate content can cause noticeable taste and a laxative (gastrointestinal) effect. The nitrate content was very high and can cause methemoglobinemia (blue baby syndrome) which is a temporary blood disorder in the bottle fed infants. Hence, parents should be advised not to give this water to infants. In conclusion, all physicochemical parameters except for nitrate are safe for health but may affect the appearance and taste, and wear water infrastructures. A high value of turbidity due to suspended minerals is the cause for milky-white colour. However, a mineralogical analysis of suspended sediments is required to identify the exact cause for white colour, and a study on sediment source was recommended.

Keywords: Water Quality, physicochemical, nitrate, methemoglobinemia, hard water, laxative effect

Procedia PDF Downloads 54