Use of telemedicine for the identification and treatment of sulfamethoxazole-induced methaemoglobinemia.
Telemedicine can be used in intensive care units (ICUs) with linked electronic medical records to enable remote clinicians to assess patients and focus on those who are deviating from their expected course. We report the case of a woman admitted to our ICU with apparent hypoxaemia, whose pulse oximetry readings were not believed by the treating team. The intensivist at the telemedicine centre was consulted and instituted treatment on the assumption that methaemoglobinemia was present. Without rapid therapy, ongoing tissue ischaemia and shock was inevitable. Within 60 min of methylene blue administration, the patient's oxygen saturation improved dramatically. The methaemoglobin level was eventually reported as 9.9% (normal value <1%). This case report demonstrates how, with the aid of a tele-intensivist, a rare diagnosis was made rapidly and successful therapy was provided.
Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Founders Building 5074, SICU Administration, Philadelphia, PA 19104, USA. KohlBE@uphs.upenn.edu
Benjamin A
BA
Kohl
Ann
A
Domski
Kimberly
K
Pavan
Margaret
M
Fortino
D000890:Anti-Infective Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008708:Methemoglobinemia / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy; D008751:Methylene Blue / Q000627:therapeutic use; D008875:Middle Aged; D013420:Sulfamethoxazole / Q000009:adverse effects*; D017216:Telemedicine
D000890:Anti-Infective Agents; D013420:Sulfamethoxazole; D008751:Methylene Blue