American journal of therapeutics
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Methemoglobinemia, an increased concentration of methemoglobin in the blood, is an altered state of hemoglobin whereby the ferrous form of iron is oxidized to the ferric state, rendering the heme moiety incapable of carrying oxygen. This can cause hypoxia, cyanosis, or even death. ⋯ We report a case of severe acquired methemoglobinemia resulting from topical benzocaine use before transesophageal echocardiography. This case serves to highlight the severity of methemoglobinemia that can result from an otherwise innocuous agent even in small doses and the fact that prompt recognition and treatment of this disorder can be lifesaving.
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The objective of this study was to evaluate the effect of hormone replacement therapy (HRT) regimens on left ventricular diastolic function by using mitral pulsed wave Doppler (MPWD) and tissue Doppler velocities (TDE). Seventy-eight postmenopausal women with normotensive and impaired diastolic left ventricular filling were included in the study. All the patients began a six-cycle HRT course. ⋯ TDE parameters were independent from the preload and did not produce pseudonormal pattern. HRT may cause increase in the blood volume and produce pseudonormal pattern in transmitral flow. In that case, TDE may be a beneficial method for evaluation of diastolic function.
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Fomepizole (Antizol) was recently approved by the US Food and Drug Administration for treatment of methanol poisoning. By inhibiting the hepatic enzyme alcohol dehydrogenase, it presents formation of toxic metabolites with far fewer consequences than traditional ethanol therapy. It appears that fomepizole will become standard therapy for methanol intoxication as it is for ethylene glycol poisoning.
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Torsade de pointes is a malignant dysrhythmia that has been reported in a variety of clinical settings and associated with several pharmacologic agents. Patients with a prolonged QTc for heart rate are at higher risk for the development of this arrhythmia. We review the literature supporting the relationship of haloperidol to the development of this malignant dysrhythmia. Clinicians in the critical care setting should be aware of potentially lethal drug-induced ventricular tachydysrhythmias such as torsade de pointes.