Workum Jessica D, Bisschops Laurens L A, van den Berg Maarten J W
Radboudumc, afd. Intensive Care, Nijmegen.
Ned Tijdschr Geneeskd. 2019 Mar 4;163:D3369.
We present two patients who were treated for an intentional overdose of sodium nitrite. When ingested sodium nitrite leads to severe methaemoglobinaemia, resulting in severe hypoxia (as methaemoglobin does not transport oxygen), vasodilation and hypotension. Symptoms include cyanosis, headache, nausea, convulsions, coma and death. When measured by pulse oximetry, patients with a sodium nitrite intoxication and severe methaemoglobinaemia generally have an oxygen saturation of around 85%. This value is unreliable as the oxygen content of the blood is often extremely low - this can be confirmed by arterial blood gas analysis. Treatment of sodium nitrite intoxication consists of intravenous administration of methylthioninium chloride 1-2 mg/kg. Methylthioninium chloride converts the methaemoglobin back to haemoglobin. Due to the pharmacokinetics of methylthioninium chloride and sodium nitrite, a rebound effect is not to be expected. The only contra-indication for methylthioninium chloride is glucose-6-phosphate dehydrogenase deficiency, which is extremely rare in the Netherlands.
我们报告了两名因故意过量摄入亚硝酸钠而接受治疗的患者。摄入亚硝酸钠会导致严重的高铁血红蛋白血症，进而导致严重缺氧（因为高铁血红蛋白不运输氧气）、血管舒张和低血压。症状包括发绀、头痛、恶心、抽搐、昏迷和死亡。通过脉搏血氧饱和度测定法测量时，亚硝酸钠中毒且患有严重高铁血红蛋白血症的患者的血氧饱和度通常约为85%。由于血液中的氧含量往往极低，这个值并不可靠——这可通过动脉血气分析来证实。亚硝酸钠中毒的治疗包括静脉注射1 - 2 mg/kg的亚甲蓝。亚甲蓝可将高铁血红蛋白转化回血红蛋白。由于亚甲蓝和亚硝酸钠的药代动力学，预期不会出现反跳效应。亚甲蓝唯一的禁忌症是葡萄糖 - 6 - 磷酸脱氢酶缺乏症，这在荷兰极为罕见。
