Clinical toxicology : the official journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
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Clin Toxicol (Phila) · May 2018
Case ReportsAcquired methemoglobinemia after hydroxocobalamin administration in a patient with burns and inhalation injury.
Hydroxocobalamin is an effective cyanide antidote. While erythema, hypertension, and chromaturia are recognized side effects, methemoglobinemia has not been reported. Methemoglobin levels are most accurately measured by co-oximetry. We describe an extensively burned patient who developed methemoglobinemia within an hour of hydroxocobalamin administration. ⋯ Methemoglobinemia in our patient was temporally associated with hydroxocobalamin administration.
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Clin Toxicol (Phila) · May 2018
Case ReportsInverted Takotsubo syndrome in Androctonus australis scorpion envenomation.
The nature of scorpion-related cardiomyopathy is still a matter of debate where specific toxin-induced cardiomyopathy, ischemic, or catecholaminergic cardiomyopathy is advocated as well. We report two cases of Takotsubo syndrome following envenomation by Androctonus australis, bringing new evidence for the fundamental role of catecholamines in the pathogenesis of this cardiomyopathy. Case 1: A woman aged 36 presented with pulmonary edema and shock following scorpion envenomation. Echocardiography-Doppler showed a LVEF at 30%. Cardiac magnetic resonance (CMR) imaging showed a basal ballooning of the left and right ventricles suggestive of an inverted biventricular Takotsubo syndrome. A second CMR performed after recovery was normal. Case 2: A woman aged 45 was admitted for pulmonary edema and shock consecutive to scorpion envenomation. Echocardiography showed a LVEF at 35%. CMR showed a basal ballooning. The patient was discharged four days following admission with a normal LV function on repeat echocardiography examination. ⋯ Cardiomyopathy in these cases, following scorpion envenomation by Androctonus australis, fulfills the criteria of Takotsubo syndrome. These observations contribute to our understanding of the mechanism, prognosis, and treatment of scorpion-related cardiomyopathy.