Arch Intern Med
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Acute methemoglobinemia may result from the use of several local anesthetic agents. Benzocaine (Cetacaine) spray has been shown previously to cause methemoglobinemia in two patients when applied topically to the mucous membranes. ⋯ The episodes occurred more than 20 hours apart, and no other drugs known to induce methemoglobinemia were given. On both occasions, intravenous methylene blue was effective in correcting the disorder.
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Thrombotic thrombocytopenic purpura (TTP), a disease of unknown cause, has been reported relatively frequently during pregnancy. The disorder typically runs a fulminant course with a high mortality, and survival of both mother and fetus has been exceedingly rare. We report here the fourth case of TTP during pregnancy in which both the mother and fetus survived. ⋯ The patient described herein was refractory to corticosteroids, antiplatelet agents, and only transiently responsive to exchange transfusion. The administration of plasma infusions achieved a sustained partial remission that allowed full gestation of the developing fetus. The patient attained full remission following cesarean section and simultaneous splenectomy.
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Case Reports
Survival after prolonged submersion in cold water without neurologic sequelae. Report of two cases.
We describe two patients who suffered prolonged (greater than four minutes) submersion in cold water (25 minutes, 32 s, and six minutes, respectively), with complete neurologic recovery. We postulate that hypothermia served to protect the brain from hypoxic injury. These cases also serve to emphasize the need for vigorous one-the-scene resuscitative efforts. We review the problems associated with the treatment of hypothermia and drowning.
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The metabolic and respiratory changes of 21 patients with heat stroke were studied. Admission arterial blood gas levels were measured, and serum bicarbonate, lactate, calcium, phosphorus, and anion gap determinations were performed. Seven patients had a metabolic acidosis (pH 7.20 +/- 0.04, PCO2 32 +/- 2 mm Hg, and bicarbonate 12 +/- 1 mEq/L), seven a combined metabolic acidosis and respiratory alkalosis (pH 7.39 +/- 0.01, PCO2 25 +/- 1 mm Hg, and bicarbonate 15 +/- 1 mEq/L), four a respiratory alkalosis (pH 7.45 +/- 0.01, PCO2 30 +/- 1 mm Hg, and bicarbonate 20 +/- 1 mEq/L), one a metabolic and respiratory acidosis (pH 7.13, PCO2 52 mm Hg, and bicarbonate 17 mEq/L), and one a respiratory acidosis (pH 7.30, PCO2 56 MM Hg, and bicarbonate 27 mEq/L). ⋯ Nine patients were hypocalcemic (7.8 +/- 0.3 mg/dL), and five patients were hypophosphatemic (2.0 +/- 0.2 mg/dL). The predominant metabolic change in heat stroke is a metabolic acidosis secondary to increased lactate content and/or a respiratory alkalosis. Hypocalcemia is common and hypophosphatemia is not infrequent.