Yoğun Bakım Ünitesinde Methemoglebinemi ve Yönetimi
Özet
Methemoglobinemi, akut dispnenin nadir nedenlerinden biri olup hızla tanı konulup tedavi edilmediği taktirde ölümle sonuçlanabilmektedir. Methemoglobinemi, doğuştan ya da sonradan edinsel olarak ortaya çıkabilir. Edinilmiş methemoglobinemi daha sık görülmektedir ve çoğunlukla ilaçlar ya da toksik ajanlara maruziyet sonrası gelişir. Methemoglobinemi, özellikle ameliyathanelerde ve yoğun bakım ünitelerinde izlenen hastalarda daha sık görülmektedir. Bu yazıda Hipertansiyon, tip 2 diyabet ve septisemi tanıları bulunan bir hastada parenteral gliserol trinitrat (nitrogliserin) tedavisi nedeniyle gelişen ilaç ilişkili bir methemoglobinemi olgusu paylaşıldı. Methemoglobinemi nedeni ile belirgin dispneik seyreden hastanın hemen nitrogliserin infüzyonu kesildi ve antidot tedavisi için intravenöz (i.v.) olarak metilen mavisi (M.B.) tedavisi verildi. Hastaya bir saat ara ile toplam iki defa M.B. tedavisi uygulandı ve yaklaşık 8 saat içerisinde dispne şikayeti geriledi. Hastanın seri bakılan arteriyel kan gazı (AKG) örneklerinde methemoglobin (MetHb) düzeyi normale geriledi. Septisemisi düzelen ve normotansif hale gelen hasta yoğun bakım ünitesinden taburcu edildi.
Methemoglobinemia is a rare cause of acute dyspnea and can result in death if not diagnosed and treated promptly. Methemoglobinemia can occur congenitally or acquired. Acquired methemoglobinemia is more common and mostly develops after exposure to drugs or toxic agents. Methemoglobinemia is more common especially in patients monitored in operating rooms and intensive care units. In this article, a case of drug-related methemoglobinemia that developed due to parenteral glycerol trinitrate (nitroglycerin) treatment in a patient diagnosed with hypertension, type 2 diabetes and septicemia is shared. The patient, who was significantly dyspneic due to methemoglobinemia, had his nitroglycerin infusion stopped immediately and methylene blue (M.B.) was given intravenously (i.v.) for antidote treatment. The patient was given M.B. twice in total at one hour intervals. treatment was applied and dyspnea complaints decreased within approximately 8 hours. The patient's methemoglobin (MetHb) level decreased to normal in serial arterial blood gas (ABG) samples. The patient, whose septicemia resolved and who became normotensive, was discharged from the intensive care unit.
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