title: Hemodialysis-associated methemoglobinemia in acute renal failure.
abstract: Patients on maintenance hemodialysis are vulnerable to chloramine toxicity if chloramines are inadequately removed. We report two critically ill patients with acute renal failure who developed methemoglobinemia during hemodialysis in the intensive care unit. During the same period, methemoglobin levels measured from 30 patients in the outpatient dialysis facility were undetectable. Methemoglobin levels normalized when the carbon filtration system of the portable dialysis machine was replaced with a larger unit to remove chloramines more effectively. Causes, treatment, and prevention of chloramine toxicity in patients receiving dialysis in the intensive care unit are discussed.
authors.affiliation: Division of Pulmonary/Critical Care Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA.
authors.forename: Juan P
authors.initials: JP
authors.lastname: de Torres
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: DeTorres
authors.forename: James A
authors.initials: JA
authors.lastname: Strom
authors.forename: Bertrand L
authors.initials: BL
authors.lastname: Jaber
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Hendra
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D003666:Decontamination; D005260:Female; D005374:Filtration / Q000295:instrumentation; D006801:Humans; D008297:Male; D008708:Methemoglobinemia / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation