• Journal of The Korean Society of Clinical Toxicology
• /
• v.6 no.2
• /
• pp.134-137
• /
• 2008

Methylene blue is the first choice for treating methemoglobinemia, any increase in normal methemoglobin levels. Methemoglobin is an abnormal hemoglobin in which the iron has been oxidized to the ferric(+3) state, making it incapable of oxygen transport. Methemoglobinemia most commonly results from exposure to oxidizing chemicals, but may also arise form genetic, dietary, or even idiopathic etiologies. Patients with low methemoglobin levels are asymptomatic, but high methemoglobin levels can lead to headaches or even death. Methylene blue, the first-line treatment for methemoglobinemia, can also produce hemolytic anemia. Jaundice or dark urine during methylene blue treatment may indicate hemolytic anemia. A 47-year-old female patient with a history of depressive mood disorder developed significant methemoglobinemia after ingesting a Propanil overdose. Twenty-two hours after ingestion, methemoglobin levels in the blood were 73.2%. She was treated with intravenous methylene blue in the therapeutic range (1 mg/kg every 4 h for 3days). The 2nd day after methylene blue use, methemoglobin levels in the blood were 33%, and the 5th day decreased to 10% with better general condition. The patient had hyperbilirubinemia after hemolytic anemia, but she recovered completely.

• 월간산업보건
• /
• s.61
• /
• pp.20-28
• /
• 1993

• Journal of The Korean Society of Clinical Toxicology
• /
• v.4 no.2
• /
• pp.170-174
• /
• 2006

Methylene blue is a basic thiazine dye frequently used for histologic staining. In clinical toxicology settings, it is also used to treat clinically significant methemoglobinemia. It has dose-dependent oxidation or reduction properties, acting as a reducing agent at lower doses and as an oxidizing agent at higher doses. Hemolytic anemia and hyperbilirubinemia are known toxic effects of methylene blue treatment that have been reported clinically. A 42-year-old woman developed significant methemoglobinemia after acute dapsone overdose; she was treated appropriately with intravenous methylene blue in the therapeutic range. The patient's methemoglobin levels returned to normal. However, 2-4 days later she was noted to have rebound methemoglobinemia, hemolytic anemia, and hyperbilirubinemia. A repeat of Coomb's test and other anemia workups were negative. For management of methylene blue-induced hemolytic anemia, she was administered steroid therapy, N-acetylcysteine, and a blood transfusion. She ultimately recovered, and there were no long-term sequelae from the methylene blue poisoning.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.8 no.1
• /
• pp.1-6
• /
• 2010

Methylene blue is a very effective reducer of drug-induced methemoglobinemia. It has dose-dependent oxidation or reduction properties. In most cases, a dose of 1 to 2 mg/kg IV given over 5 minutes and immediately followed by a 15- to 30-mL fluid flush to minimize the local pain is both effective and relatively safe. The onset of action is quite rapid, and the effects are usually seen within 30 minutes. The dose may be repeated after 30 to 60 minutes and then every 2 to 4 hours as needed. The total dose should not exceed 7 mg/kg as a single dose or 15 mg/kg within 24 hours. Repeated treatment may be needed for treating compounds that have prolonged elimination or those compounds that undergo enterohepatic recirculation (e.g., dapsone). Methylene blue can cause dose-related toxicity. At high doses, methylene blue can also induce an acute hemolytic anemia and rebound methemoglobinemia. The reasons for treatment failure with methylene blue include ineffective GI decontamination, the existence of other forms of hemoglobin (e.g., sulfhemoglobin), a low or high dose of methylene blue and the toxicokinetics of some agents, such as aniline, benzocaine or dapsone.

• Clinical and Experimental Pediatrics
• /
• v.52 no.3
• /
• pp.385-388
• /
• 2009

An 8-year-old girl visited the emergency room with perioral cyanosis and dyspnea, which had developed 20 hrs prior to the hospital visit. She had taken a Chinese herbal medication for 3 days prior to the onset of the symptoms. A co-oximeter examination revealed a methemoglobin level of 23.7%. An intravenous infusion of methylene blue was administered. Chemical analysis of the herbal medication revealed an ammonia (NH$_{3}$) level of 239.41 mg/L. More studies are needed on the correlation between methemoglobinemia and the components of Chinese herbal medicines.

• Journal of fish pathology
• /
• v.20 no.3
• /
• pp.291-297
• /
• 2007

The effect of aspirin on the recovery of nitrite-induced methemoglobinemia in cultured eels (Anguilla japonica) was studied. Methemoglobinemia was induced by exposing eels to nitrite (120 ㎎ NO2-N/ℓ) for 24 hr. The nitrite exposed eels were bathed in 20 ppm aspirin solution (Aspirin), 0.8 % NaCl solution (NaCl), 20 ppm aspirin plus 0.8% NaCl solution (NaCl + Aspirin) and 50% nitrite free water(control) for 24 hr to recover from nitrite toxicity. Peripheral blood was taken from the arterious bulb from all groups to analyse hematocrit value, hemoglobin concentration, and nitrite concentration of the blood. Histopathological features of gill were also observed. Aspirin and control groups were more effective than NaCl and NaCl + Aspirin groups in recovery of hematocrit value and hemoglobin concentration, methemoglobin rate and nitrite concentration. The histopathological features on the gill of aspirin group were similar to those of normal eels, but other groups showed focal hyperemia in the lamellar carpillaries, epithelial hyperplasia. These results suggested that aspirin was very effective to recover from methemoglobinemia in nitrite-induced cultured eels.

• Archives of Pharmacal Research
• /
• v.22 no.6
• /
• pp.565-570
• /
• 1999

DW2282,(S)-(+)-4-phenyl-1-[1-(4-aminobenzoyl)-indoline-5-sulfonyl]-4,5-dihydro-2-imidazolone hydrochloride, is a new anticancer agent which is thought to exhibit a characteristic mechanism of action in the inhibition of tumor growth. In this study, we estimated the toxicities of DW2282 in mice. When mice were orally dosed for five consecutive days at the dosages of 50, 100 and 150 mg/kg, DW2282 did not induced methemoglobinemia and hypoglycemia at any of these doses. However, increased ALT and AST values were observed in the 150 mg/kg dosing group, and white blood cells (WBC) were significantly decreased at all doses. However, the changes in WBC count, ALT and AST immediately reversed after the cessation of drug administration. In addition, we found that DW2282 did not cause an increase in hemolysis in human blood. Taken together, these data suggested that DW2282 may have a relatively low level of toxicity, and that there may be a quick recovery from any toxicity it dose produce.

• 대한예방의학회:학술대회논문집
• /
• 1993.10a
• /
• pp.109-110
• /
• 1993

• Clean Technology
• /
• v.3 no.2
• /
• pp.31-33
• /
• 1997

Nitrate contamination in surface water and ground water have increased in Korea. This trend has raised concern because nitrates caused methemoglobinemia in infants. To remove nitrates from waters, various purification processes including ion-exchange, biological denitrification, and chemical denitrification are currently in use for the treatment of water. However, little economically advantageous process exists for the industrial scale treatment of effluents highly polluted with nitrates. A new process has been developed for nitrate and other salts removal from polluted waters. Alumina cement and lime served as precipitating agents to remove nitrate with stirring at basic pH. Decreasing alumina content in alumina cement result in a increasing in nitrate removal yield. Stable removal of nitrate(1000mg/L) was readily achieved by two-stage removal process.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.22 no.6
• /
• pp.419-426
• /
• 2022

Topical anesthetics are routinely used in dental practice for various purposes. They are usually available at higher dosages and have serious potential adverse reactions, such as seizures, anaphylaxis, and acquired methemoglobinemia. To date, the scope of application of herbal plants and their extracts, which have medicinal properties, has been elaborated in the field of dentistry. The growing interest in herbal medication can be attributed to the increased safety profile of herbal agents, in contrast to synthetic preparations that have a higher risk of systemic complications. Herbal preparations can induce topical anesthesia with minimal side effects. Recently, many studies have reported the use of topical herbal preparations. The current review aimed to evaluate data from various articles comparing the capacity of herbal topical anesthetic formulations and conventional synthetic anesthetics in reducing pain perception when used as local anesthesia before dental procedures.