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Nitrobenzene Poisoning


Presentation

  • Pulse oximeters available at present are not useful in patients treated with methylene blue and should be used cautiously in the presence of cyanosis of unknown aetiology.[ncbi.nlm.nih.gov]
Severe Pain
  • There was a history of severe pain in the abdomen, nausea, Late presentation of secondary cycling International Archives of Integrated Medicine, Vol.[documents.tips]
  • Significant history of severe pain in the abdomen, nausea,methemoglobinemia due to acute nitrobenzenepoisoning is uncommon and rare but lifethreatening emergency condition.[pubhtml5.com]
Lymphadenopathy
  • There was no pallor, icterus, cyanosis, lymphadenopathy, head lag, respiratory distress, pungent odor of the organophosphorus compounds, flaps, or altered mental status.[mjmsr.net]
Splenomegaly
  • Here author highlights the rare occurrence of such cases, methaemoglobin induced severe oxidative stress, unexplained splenomegaly and leucocytosis and the ineffectivity of oral methylene blue and other supportive measures in evading death due to nitrobenzene[ncbi.nlm.nih.gov]
  • Altered liver function tests, hepato-splenomegaly, and Heinz body haemolytic ficant features [4, 21, ].[documents.tips]
Aspiration
  • Ten days after her arrival to our center, she unfortunately passed away secondary to aspiration pneumonitis, sepsis, and toxic brain injury due to nitrobenzene. Nitrobenzene is used as a paint solvent and dye in screen painting.[ijabmr.org]
Nausea
  • Symptoms of acute poisoning include headache, drowsiness, nausea, ataxia, cyanosis, and, in extreme cases, respiratory failure. Chronic exposure to nitrobenzene may cause headache, fatigue, loss of appetite, and anemia.[medical-dictionary.thefreedictionary.com]
  • The symptoms and signs of poisoning are nausea, vomiting, prostration, intense gray blue cyanosis, convulsions, and coma (Sollmann). As with other benzene derivatives, there is a direct toxic effect FULL TEXT[annals.org]
  • In normal individuals methaemoglobin level must be greater than 10% to be clinically recognized and only mild symptoms, headache, fatigue and nausea occur at level of 20-30% [4].[jpgmonline.com]
  • It causes methemoglobinemia with symptoms including headache, nausea, dizziness, fatigue, shortness of breath, cyanosis, and convulsions. Severe acute exposure to nitrobenzene can cause jaundice, renal failure, and coma, and it may be fatal.[amhsjournal.org]
  • Patient complained of epigastric discomfort and nausea. She did not have any vomiting, loss of consciousness, or seizures while being transferred to the hospital.[mjmsr.net]
Loss of Appetite
Recurrent Vomiting
  • She was then taken to a local hospital where she presented with recurrent vomiting, headache, and light-headedness. She had a gastric lavage done and started on supportive treatment with intravenous fluids and intravenous paracetamol.[ijabmr.org]
Headache
  • Symptoms of acute poisoning include headache, drowsiness, nausea, ataxia, cyanosis, and, in extreme cases, respiratory failure. Chronic exposure to nitrobenzene may cause headache, fatigue, loss of appetite, and anemia.[medical-dictionary.thefreedictionary.com]
  • She was then taken to a local hospital where she presented with recurrent vomiting, headache, and light-headedness. She had a gastric lavage done and started on supportive treatment with intravenous fluids and intravenous paracetamol.[ijabmr.org]
  • Beyond 20%, headache, dyspnea, chest pain, tachypnea, and tachycardia develop.[amhsjournal.org]
  • In normal individuals methaemoglobin level must be greater than 10% to be clinically recognized and only mild symptoms, headache, fatigue and nausea occur at level of 20-30% [4].[jpgmonline.com]
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
Stupor
  • […] oximetry is inaccurate in determining oxygenation levels in toxic patients. [7] In toxic doses, patients will have acute symptoms of nausea, vomiting, and headache followed by dyspnea, tachycardia, arrhythmias, shock, seizures, altered sensorium, and stupor[ijabmr.org]
  • This was manifest in our patient as stupor, tachycardia, hypotension and respiratory depression. Methaemoglobin is a dark pigment that causes venous blood to appear chocolate brown. Bubbling oxygen through it does not change the colour.[docslide.com.br]

Workup

  • Methemglobinemia: Differential diagnoses and workup, e medicine from web med. Available from: 2010. 25. Curry S. Methaemoglobinemia. Ann Emerg Med, 1982; 11:26. Whitwan JG, Taylor AR, White JM. Potential hazard of methylene blue.[documents.tips]
  • A case of methemoglobinemia Methemglobinemia: Differentialcaused by hair dyeing with henna. diagnoses and workup, e medicine fromKorean J Med, 2007; 72(2): 314–317. web med. Available14.[pubhtml5.com]
  • (See Workup.) The most important aspects of the management of methemoglobinemia are recognition of the condition and prompt initiation of treatment, when indicated.[emedicine.medscape.com]
Anisopoikilocytosis
  • Peripheral smear showed moderate anisopoikilocytosis and presence of red cell fragments. Intravenous methylene blue was given in view of high suspicion of acute MetHb.[ijabmr.org]

Treatment

  • Important factors in treatment are discussed. These include, gastric lavage, the administration of methylene blue and exchange transfusion. The possibility of a late haemolytic reaction being a complication of methylene blue treatment is mentioned.[unboundmedicine.com]
  • Methylene blue and exchange transfusion were the therapeutic methods applied in the treatment of the methemoglobinemia. Forty-eight hours after ingestion, a blood sample was collected in ICU and sent to our laboratory.[ncbi.nlm.nih.gov]
  • Plan of management is based upon the principles of decontamination along with symptomatic and supportive treatment. lue is the drug of choice (antidote) for the treatment of acquired (toxic) ].[documents.tips]
  • Methemogobinemia can leads to safety (IPCS) – 2003 (8.11)high mortality but effective treatment with Nitrobenzene. Environmental healthmethylene blue is preferential. criteria 230. Geneva: WHO.[pubhtml5.com]

Prognosis

  • Younger age indicated a better prognosis. The absence of oculovestibular, oculocephalic reflexes, pupillary reflexes and / corneal reflexes suggests, poor outcome. The patient with low coma score of 3 to 4 had poorer prognosis.[japi.org]
  • Please find relevant information on First Aid for Fountain Pen Ink Poisoning regarding cause, signs & symptoms, administration of first aid treatment, prognosis, preventive measures, and additional resources HERE .[dovemed.com]
  • Prognosis The prognosis of mild cases of methemoglobinemia is very favorable. In severe cases, the prognosis is determined by the degree of anoxic end-organ damage.[emedicine.medscape.com]

Etiology

  • Methemoglobinemia: Etiology, pharmacology, and clinical management. Ann Emerg Med 1999;34:646-56. [ PUBMED ] 2. Gupta A, Jain N, Agrawal A, Khanna A, Gutch M. A fatal case of severe methaemoglobinemia due to nitrobenzene poisoning.[ijabmr.org]
  • Conclusion: The most common cause of fever with acute onset altered sensorium, is an infective etiology, however noninfectious causes remain an important, but uncommon cause and proper diagnosis is sometimes missed in cases with accompanying complaints[japi.org]
  • The presence of anemia and cyanosis despite oxygen treatment results from both of these effects. [4, 5] (See Pathophysiology and Etiology.) Methemoglobinemia occurs when red blood cells (RBCs) contain methemoglobin at levels higher than 1%.[emedicine.medscape.com]
  • Methemoglobinemia: etiology, pharmacology and clinical management. Annals of Emergency Medicine. 1999; 34: 646-56. 7. Dewan A, Patel AB, Saiyed HN. Acute methemoglobinemia- A common occupational hazard in an industrial city in western India.[ispub.com]

Epidemiology

  • Abstract Clinical and epidemiological information was collected on 1033 cases of poisoning which occurred during a period of 18 months.[pediatrics.aappublications.org]
  • These events are inadequately characterised and their quantification has been difficult due to limitations imposed by lack of clarity about its epidemiology and pathophysiology and also due to lack of any standardized te sting methods.[japi.org]
  • Indigo carmine Resorcinol Metoclopramide [50] Antibiotics – Sulfonamides, nitrofurans, and para-aminosalicylic acid Industrial/household agents – Aniline dyes, nitrobenzene, naphthalene (moth balls), aminophenol, and nitroethane (nail polish remover) Epidemiology[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Additional pathophysiology content helps you better understand the effects of diseases and injuries on the body’s normal physiologic processes.[books.google.com]
  • Chemical burns: Pathophysiology and treatment. Burns. 2010;36(3):295–304. Web of Science Crossref Google Scholar [13] Cortazzo JA, Lichtman AD. Methemoglobinemia: A Review and recommendations for management. J Cardiothorac Vasc Anesth.[degruyter.com]
  • Physicians must be aware of common substance containing nitrobenzene compound, pathophysiology of these compound, and its complications and treatment modalities. References 1. International Programme on Chemical Safety (IPCS). Nitrobenzene.[amhsjournal.org]
  • Pathophysiology RBCs contain hemoglobin, which has a quaternary structure. Each hemoglobin molecule is composed of 4 polypeptide chains.[emedicine.medscape.com]
  • These events are inadequately characterised and their quantification has been difficult due to limitations imposed by lack of clarity about its epidemiology and pathophysiology and also due to lack of any standardized te sting methods.[japi.org]

Prevention

  • It is also important to take care of the secondary cycling of nitrobenzene from body stores to prevent secondary recurrence of symptoms in patients after heavy exposure.[ncbi.nlm.nih.gov]
  • Updated health promotion content includes Health Promotion boxes focusing on preventive strategies for achieving prenatal wellness, health during pregnancy, postnatal health, and pediatric illness prevention and wellness -- including the complete immunization[books.google.com]
  • Immediate identification based on clinical features, odour of the compound with supporting evidence of increased methaemoglobin levels will help in a timely intervention thus preventing fatal outcome.[ijmrhs.com]
  • The importance of early identification of the compound on the basis of clinical suspicion corroborative with methemoglobin levels with timely intervention is required to prevent fatal outcome (Agrawal et al., 2011).[journalcra.com]
  • Oral charcoal and purgation up to five days helped to elimibody stores of nitrobenzene and prevented secondary deterioration in the patientcare of nutrition, adequate urine output, and hepatoprotection prevented kidney and liver failure, which have been[documents.tips]

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