who were referred to us between March 2008 and March 2016, hospitalized with diagnosis of ... (death versus survival). The patients were assigned one of two.
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ABSTRACTS
245. Can duration of hemodialysis be estimated based on the on-arrival laboratory tests and clinical manifestations in methanol-poisoned patients? Abdolkarim Pajoumand, Nasim Zamani, Hossein Hassanian-Moghaddam and Shahin Shadnia Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran Objective: We aimed to evaluate the efficacy of the Lachance formula [1] and more readily available clinical or laboratory factors (other than serum methanol concentration) in the prediction of the time required for hemodialysis (HD) in methanol-poisoned patients. Methods: In a retrospective cross-sectional study, all patients who were referred to us between March 2008 and March 2016, hospitalized with diagnosis of methanol toxicity and had undergone hemodialysis were enrolled. A questionnaire collected information on: demographic characteristics, time elapsed between ingestion and hospital presentation, signs and symptoms on presentation, on-arrival vital signs, biochemistry and venous blood gas analysis, number of the dialysis episodes and total duration of dialysis, place the dialysis was performed, cause of repetition of dialysis (persistent acidosis, persistent visual disturbances, and methanol concentration greater than 20 mg/dL after the first session of HD), methanol concentration on presentation, time estimated for hemodialysis based on the Lachance formula, hospitalization period, and patients' final outcome (death versus survival). The patients were assigned one of two groups: those who were dialyzed adequately based on the formula estimation and those who were over- or underestimated based on the formula. Total duration of dialysis (in one or two sessions of HD) was also calculated. The patients were then evaluated to see if the formula could reliably predict duration of dialysis. In the next phase, we searched for other factors that could prognosticate the duration of HD. Results: Of 72 patients enrolled, 54 underwent hemodialysis once (group 1) and 18 needed more than one session of hemodialysis (group 2). All were treated with ethanol, bicarbonate and leucovorin (folinic acid). The Lachance formula overestimated the patients with higher methanol concentrations and underestimated those with lower methanol concentrations. It properly predicted the time required for hemodialysis when the methanol concentration was between 15 and 25 mg/dL. After performance of logistic regression analysis, creatinine was the only factor that significantly predicted the time needed for HD (p ¼ .02). Median creatinine concentrations were 1.3 [1, 6, 0.8–2.7) and 1.4 [1.35, 2.1, 0.8–6.5) in the patients who were dialyzed once and twice, respectively. Conclusion: Creatinine is possibly a readily available test that can predict the appropriate time required for hemodialysis in methanol-poisoned patients.
Reference [1]
Lachance P, Mac-Way F, Desmeules S, et al. Prediction and validation of hemodialysis duration in acute methanol poisoning. Kidney Int. 2015;88:1170–1177.
246. Emergency anesthetic management of dapsone-induced methemoglobinemia: a case report Radu C. Tincu, Cristian S. Cobilinschi and Radu A. Macovei Carol Davila University, Bucharest, Romania Objective: Dapsone represents a therapeutic alternative for patients diagnosed with panniculitis. Methemoglobinemia (MetHb) is a potentially serious adverse reaction in dapsonetreated patients. A MetHb concentration exceeding 40% is associated with coma and 70% or more can be lethal. The diagnosis and early treatment of MetHb is essential for proper anesthetic management. Case report: We report a case of a 38-year-old female who was transferred from a Rheumatology Department into our Intensive Care Unit. She had been diagnosed with Weber-Christian’s disease (idiopathic lobular panniculitis) over 14 years previously, which had required dapsone 100 mg daily for one month. On hospital admission, the patient presented severe dyspnea, marked fatigue, peripheral cyanosis and significant metrorrhagia. The initial examination showed an altered clinical state, tachypnea with orthopnea, vesicular murmur at pulmonary auscultation, decreased oxygen saturation, tachycardia and normal urinary output. Laboratory investigations revealed a MetHb concentration of 38% and normocytic normochromic anemia with a hemoglobin of 4.8 g/dL. Based on both clinical and biological investigations, we could rule out acute myocardial infarction, acute cardiac insufficiency or a thromboembolic event. Our medical team initiated electrolyte rebalancing, oxygen therapy, erythrocyte mass transfusion, gastric protection, diuretic agents, corticotherapy, vitamin supplementation and targeted therapy, including methylene blue (2 g per day), N-acetylcysteine (900 mg per day) and high dose of ascorbic acid (2 g per day), with rapid favorable evolution regarding MetHb concentration and respiratory function. A hysterectomy under general anesthesia was performed. Due to the long half-life of dapsone (up to 72 hours) and the possibility of rebound methemoglobinemia we decided to maintain mechanical ventilation. Indeed, the patient experienced a high concentration of MetHb 6 hour post-intervention despite continuous methylene blue infusion but she had recovered at 48 hours, enabling extubating and she was discharged on the 8th day. Conclusion: As methemoglobinemia can occur with standard dapsone dosage, regular monitoring is required. The present case report emphasizes the importance of diagnosis and aggressive treatment of methemoglobinemia, particularly when a subsequent surgical intervention is necessary, in order to wisely choose the time window when the patient may survive an anesthetic procedure. Maintenance of mechanical ventilation and antidote administration may need to be continued after surgery because of MetHb rebound and respiratory failure.
247. Fetal deaths as reported to the USA National Poison Data System, 2011–2015 Kristin McCloskey, David Goldberger and David Vearrier Drexel University College of Medicine, Philadelphia, USA Objective: There is a scarcity of literature reporting toxicologic exposures in pregnancy resulting in fetal death. Our objective
