title: A case of severe chlorite poisoning successfully treated with early administration of methylene blue, renal replacement therapy, and red blood cell transfusion: case report.
abstract: The case of a 55-year-old man who attempted suicide by ingesting <100 mL of 28% sodium chlorite solution is presented. On arrival in the intensive care unit, the patient appeared cyanotic with lowered consciousness and displayed anuria and chocolate brown serum.Initial laboratory tests revealed 40% of methemoglobin. The formation of methemoglobin was effectively treated with methylene blue (10% after 29 hours).To remove the toxin, and because of the anuric acute renal failure, the patient received renal replacement therapy. Despite these therapeutic measures, the patient developed hemolytic anemia and disseminated intravascular coagulation, which were treated with red blood cell transfusion and intermittent hemodialysis. These interventions led to the improvement of his condition and the patient eventually fully recovered. Patient gave written informed consent.This is the third known case of chlorite poisoning that has been reported. Based upon this case, we suggest the management of sodium chlorite poisoning to comprise the early administration of methylene blue, in addition to renal replacement therapy and transfusion of red blood cells.
authors.affiliation: University Hospital Bratislava, Nemocnica Ruzinov, ICU, KAIM, Clinic of Anesthesiology and Intensive Care Medicine, Faculty of Medicine (AG, AD, ZF, AC, AY); Department of Pharmacology and Toxicology, Faculty of Pharmacy (PV, DV-Y), Comenius University in Bratislava, University in Bratislava, Bratislava, Slovak Republic; Department of Nephrology (MS); and Department of Clinical Pharmacy and Pharmacology (RHH), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gebhardtova
authors.forename: Peter
authors.initials: P
authors.lastname: Vavrinec
authors.forename: Diana
authors.initials: D
authors.lastname: Vavrincova-Yaghi
authors.forename: Mark
authors.initials: M
authors.lastname: Seelen
authors.forename: Anna
authors.initials: A
authors.lastname: Dobisova
authors.forename: Zora
authors.initials: Z
authors.lastname: Flassikova
authors.forename: Andrea
authors.initials: A
authors.lastname: Cikova
authors.forename: Robert H
authors.initials: RH
authors.lastname: Henning
authors.forename: Aktham
authors.initials: A
authors.lastname: Yaghi
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000628:therapy*; D000743:Anemia, Hemolytic / Q000139:chemically induced / Q000628:therapy*; D002712:Chlorides / Q000506:poisoning*; D003131:Combined Modality Therapy; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced / Q000628:therapy*; D017707:Erythrocyte Transfusion / Q000379:methods*; D006801:Humans; D008297:Male; D008706:Methemoglobin / Q000378:metabolism; D008751:Methylene Blue / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000379:methods*; D013406:Suicide, Attempted
chemical_list: D002712:Chlorides; D008706:Methemoglobin; D008751:Methylene Blue; C001599:chlorite