The American journal of medicine
-
Multiple blood specimens with different leukocyte counts from two patients with extreme leukocytosis secondary to leukemia and unexplained hypoxemia were tonometered with a gas of known oxygen concentration and the decay of oxygen tension (PO2) was measured over time. The decay in PO2 in the first 2 minutes for blood with leukocyte counts of between 55.2 X 10(3)/mm3 and 490.0 X 10(3)/mm3 ranged from 13 to 72 torr. The degree of PO2 decay was blunted by placing the blood on ice and was obliterated by adding potassium cyanide. Thus, extreme leukocytosis secondary to leukemia can cause spurious hypoxemia and spurious lowering of the mixed venous PO2 due to oxygen consumption by leukocytes ("leukocyte larceny").
-
Case Reports
Severe methanol poisoning. Application of a pharmacokinetic model for ethanol therapy and hemodialysis.
Two patients with extremely high blood methanol concentrations (260 and 282 mg/dl) were successfully treated using pharmacokinetic dosing of ethanol, hemodialysis and supportive measures. Both patients recovered completely without residual ophthalmologic deficits. Early hemodialysis and inhibition of methanol metabolism with effective ethanol concentrations were attributed to the patients' full recovery. ⋯ This dose will produce a blood ethanol concentration of approximately 100 mg/dl which can be maintained by an ethanol infusion of 66 mg/kg/hour for nondrinkers to 154 mg/kg/hour for chronic ethanol drinkers. Hemodialysis should be initiated if the blood methanol concentration is greater than 50 mg/dl. If hemodialysis is initiated, the ethanol infusion should be increased by 7.2 g/hour.