Chloroquine methemoglobin

Discussion in 'Hydroxychloroquine Sulfate' started by Kristichka, 02-Mar-2020.

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    Chloroquine methemoglobin


    Methemoglobin results from the presence of iron in the ferric form instead of the usual ferrous form. This results in a decreased availability of oxygen to the tissues.

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    Methemoglobin is not stable in samples of blood and should be measured promptly. Otherwise the measured level may be lower than the values at the time cyanosis was observed. Cyanosis with a gray-brown hue that is unresponsive to oxygen occurs when the fraction of hemoglobin existing as methemoglobin exceeds 15%. Any drug that interferes with these mechanisms can lead to methemoglobinemia.1,2 Thus, it is important to take an appropriate drug history particularly for drugs like chloroquine as was observed in our second case.1,2 Acquired methemoglobinemia incidence may be much higher than is documented. Often, this is associated with the use of or. Hemoglobin to methemoglobin, but require biochemical transformation to toxic metabolites which cause methemoglobin, example, Dapsone is metabolized by the cytochrome p-450 system to free radical hydroxylamine, which reacts with O2 to form oxygen free radicals which oxidize ferrous of hemoglobin to form methemoglobin.

    As levels rise above 15%, neurologic and cardiac symptoms arise as a consequence of hypoxia. After acute exposure to an oxidizing agent, it is advisable to treat patients with methemoglobin levels of 20% or higher (or lower levels, such as 10%, if there are significant comorbidities especially in the presence of end-organ dysfunction. This structural change causes an alteration in the blood’s ability to bind oxygen. Symptoms are proportional to the methemoglobin level and include skin color changes and blood color changes at levels up to 15% (see the image below).

    Chloroquine methemoglobin

    Chloroquine - Wikipedia, Methemoglobinemia Arterial blood gas as a diagnostic tool

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    The potassium cyanide test can distinguish between methemoglobin and sulfhemoglobin. After the addition of a few drops of potassium cyanide, methemoglobin turns bright red, but sulfhemoglobin remains dark brown. This is due to the binding of methemoglobin to cyanide, forming cyanomethemoglobin, which is bright red in color. Methemoglobinemia met-hemo-globin-emia is a condition where the quantity of methemoglobin in the red blood cells is higher than normal. It is a congenital condition, meaning that it is present from birth, but can develop in life due to exposure to certain toxins. Although methemoglobin is normally present in red blood cells, its quantity is low. Methemoglobin British methaemoglobin pronounced "met-hemoglobin" is a hemoglobin in the form of metalloprotein, in which the iron in the heme group is in the Fe 3+ state, not the Fe 2+ of normal hemoglobin. Methemoglobin cannot bind oxygen, which means it cannot carry oxygen to tissues. It is bluish chocolate-brown in color.

     
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