Bazylewicz Anna, Kłopotowski Tomasz, Kicka Mariusz, Miśkiewicz Łukasz, Picheta Sebastian
Instytut Medycyny Pracy i Zdrowia, Srodowiskowego w Sosnowcu, Oddzia Toksykologii Klinicznej z Regionalnym Ośrodkiem Ostrych Zatruć.
Przegl Lek. 2010;67(8):636-9.
Methemoglobin is an oxidized derivative of hemoglobin. It is generated by oxidization the ferrous form of iron (Fe2+) in the heme molecule to the ferric form (Fe3+). A molecule of methemoglobin is incapable of binding and carrying of oxygen. Methemoglobinemia, an increased concentration of methemoglobin in the blood above 2%, may be congenital due to deficiency or lack of specific enzymes protecting hemoglobin from oxidization or abnormal structure of hemoglobin molecule. More often methemoglobinemia is acquired as a result of accidental or intentional poisoning due to chemical substances oxidizing hemoglobin. Some of them may induce hemolysis. Cyanosis resistant to oxygen therapy and dyspnea occur in patients with the methemoglobin concentration above 20%. Consciousness disorders, respiratory and circulatory failure, liver and kidney damage may occur in patients with high methemoglobin levels greater than 50%. Fatal cases have also been reported. In the paper we present two cases of patients who were admitted to our hospital ward. First of them regards a 21-year-old woman with the methemoglobin level of 38.3% induced by accidental inhalation exposure to aniline. The other case concerns a 49-year-old man who developed methemoglobinemia of 42.7% after suicidal ingestion of an urea-substituted herbicide containing linuron. We observed hemolysis in both of these cases. They were treated symptomatically and with a specific antidote--methylene blue.
高铁血红蛋白是血红蛋白的一种氧化衍生物。它是通过将血红素分子中的亚铁形式的铁（Fe2+）氧化为铁（Fe3+）而产生的。一个高铁血红蛋白分子不能结合和携带氧气。高铁血红蛋白血症是指血液中高铁血红蛋白浓度超过2%，可能是先天性的，原因是缺乏保护血红蛋白不被氧化的特定酶或血红蛋白分子结构异常。更常见的是，高铁血红蛋白血症是由于化学物质氧化血红蛋白导致的意外或故意中毒而获得的。其中一些可能会导致溶血。高铁血红蛋白浓度高于20%的患者会出现对氧疗有抵抗的发绀和呼吸困难。高铁血红蛋白水平高于50%的患者可能会出现意识障碍、呼吸和循环衰竭、肝和肾损伤。也有致命病例的报道。在本文中，我们介绍了两名入住我院病房的患者。其中第一例是一名21岁女性，因意外吸入苯胺导致高铁血红蛋白水平达到38.3%。另一例是一名49岁男性，在自杀性摄入含有利谷隆的尿素替代除草剂后出现了42.7%的高铁血红蛋白血症。我们在这两例中都观察到了溶血。他们接受了对症治疗并使用了特效解毒剂——亚甲蓝。
