Methemoglobinemia is a condition where the iron in hemoglobin is oxidized, preventing it from carrying oxygen. This leaves tissues hypoxic. Causes include genetic defects or exposure to drugs like dapsone or local anesthetics. Symptoms are cyanosis and breathlessness. Diagnosis uses co-oximetry or the Evelyn-Malloy test. Treatment focuses on removing causes, supplemental oxygen, and methylene blue which helps reduce methemoglobin, though not for those with G6PD deficiency due to risk of hemolysis. HIV patients on dapsone and primaquine together are particularly at risk.
This case report describes a 45-year-old male who developed methemoglobinemia after consuming an anti-termite oil in a suicidal attempt. He was unconscious with cyanosis upon presentation. Testing revealed elevated methemoglobin levels. He was treated with methylene blue, exchange transfusions, and supportive care. His cyanosis and methemoglobin levels improved over time with treatment. Methemoglobinemia is caused by oxidation of hemoglobin and can be induced by toxins like those in anti-termite oil. Methylene blue treatment works to reduce oxidized hemoglobin levels.
1. Dokumen tersebut berisi interpretasi dari 14 gambar strip EKG. Dokumen menjelaskan karakteristik gelombang dan interval serta kesimpulan diagnosis untuk setiap strip EKG.
Sickle cell anemia is a genetic blood disorder caused by a mutation in the gene for hemoglobin. In 1904, Dr. James Herrick first observed sickle-shaped red blood cells in an African American patient, which led to the discovery and naming of the disease. The mutation causes hemoglobin to form rigid sickle shapes under low oxygen conditions, which can block blood flow and damage organs. Individuals with two copies of the mutation experience symptoms while carriers with one copy are resistant to malaria.
Haemoglobin is the protein in red blood cells that transports oxygen and carbon dioxide throughout the body. It is composed of four globin protein subunits, each containing an iron-containing heme group. Haemoglobin's ability to bind and release oxygen and carbon dioxide allows it to deliver oxygen from the lungs to tissues and remove carbon dioxide from tissues back to the lungs. Several factors regulate haemoglobin's affinity for oxygen, including partial pressures of oxygen and carbon dioxide, pH, and levels of 2,3-bisphosphoglycerate in the blood. This complex regulation allows haemoglobin to efficiently load and unload gases where they are needed.
Methemoglobinemia is a condition where the iron in hemoglobin is oxidized, preventing it from carrying oxygen. This leaves tissues hypoxic. Causes include genetic defects or exposure to drugs like dapsone or local anesthetics. Symptoms are cyanosis and breathlessness. Diagnosis uses co-oximetry or the Evelyn-Malloy test. Treatment focuses on removing causes, supplemental oxygen, and methylene blue which helps reduce methemoglobin, though not for those with G6PD deficiency due to risk of hemolysis. HIV patients on dapsone and primaquine together are particularly at risk.
This case report describes a 45-year-old male who developed methemoglobinemia after consuming an anti-termite oil in a suicidal attempt. He was unconscious with cyanosis upon presentation. Testing revealed elevated methemoglobin levels. He was treated with methylene blue, exchange transfusions, and supportive care. His cyanosis and methemoglobin levels improved over time with treatment. Methemoglobinemia is caused by oxidation of hemoglobin and can be induced by toxins like those in anti-termite oil. Methylene blue treatment works to reduce oxidized hemoglobin levels.
1. Dokumen tersebut berisi interpretasi dari 14 gambar strip EKG. Dokumen menjelaskan karakteristik gelombang dan interval serta kesimpulan diagnosis untuk setiap strip EKG.
Sickle cell anemia is a genetic blood disorder caused by a mutation in the gene for hemoglobin. In 1904, Dr. James Herrick first observed sickle-shaped red blood cells in an African American patient, which led to the discovery and naming of the disease. The mutation causes hemoglobin to form rigid sickle shapes under low oxygen conditions, which can block blood flow and damage organs. Individuals with two copies of the mutation experience symptoms while carriers with one copy are resistant to malaria.
Haemoglobin is the protein in red blood cells that transports oxygen and carbon dioxide throughout the body. It is composed of four globin protein subunits, each containing an iron-containing heme group. Haemoglobin's ability to bind and release oxygen and carbon dioxide allows it to deliver oxygen from the lungs to tissues and remove carbon dioxide from tissues back to the lungs. Several factors regulate haemoglobin's affinity for oxygen, including partial pressures of oxygen and carbon dioxide, pH, and levels of 2,3-bisphosphoglycerate in the blood. This complex regulation allows haemoglobin to efficiently load and unload gases where they are needed.
The document discusses idiosyncratic reactions to anesthetics and their prevention. It defines idiosyncrasy as an individual's unique abnormal reaction to a particular drug that is genetically determined and unrelated to pharmacology or dosage. Some examples provided include prolonged paralysis from suxamethonium due to enzyme deficiency and reactions to carbamazepine and chloroquine. Prevention focuses on avoiding drugs previously causing reactions, slow injection, and close patient observation.
This document discusses thalassemia, a genetic blood disorder characterized by defective hemoglobin synthesis. There are two main types: alpha thalassemia involves defective alpha chain synthesis while beta thalassemia involves defective beta chain synthesis. Thalassemia major is the severe homozygous form while thalassemia minor is the milder heterozygous form. Symptoms include anemia, jaundice, enlarged liver and spleen, and bone changes from extramedullary hematopoiesis such as bone deformities and growth arrest lines. Management involves blood transfusions and iron chelation therapy.
This document discusses the pathogenesis and laboratory diagnosis of sickle cell anemia and thalassemia. It describes how abnormal red blood cells are destroyed in the spleen, releasing hemoglobin. The heme portion of hemoglobin is broken down into bilirubin and stored iron, while the globin portion is recycled to amino acids. This leads to anemia. Specific tests are used to diagnose these conditions based on abnormal hemoglobin levels, types or variants seen on electrophoresis or peripheral smears. Genetic testing can also identify mutations that cause these hemolytic anemias.
This document provides an overview of tachyarrhythmias, including:
- Definitions of tachyarrhythmias as disturbances in heart rhythm over 100 beats per minute.
- Anatomy and electrophysiology of the heart's conduction system.
- Mechanisms of arrhythmogenesis including disorders of impulse formation and conduction.
- Diagnostic approach involving history, physical exam, ECGs, monitoring, and invasive studies.
- Treatment modalities including antiarrhythmic drugs and ablation procedures for various specific arrhythmias like atrial fibrillation, supraventricular tachycardias, and ventricular arrhythmias.
This document provides an overview of evaluating and treating different types of tachycardia, including:
1) It discusses evaluating the patient's hemodynamic stability, history, and ECG to determine the characteristics and cause of the tachycardia.
2) It describes differentiating between narrow and wide complex tachycardias, and the differential diagnoses for each, including sinus tachycardia, atrial fibrillation, AV nodal reentrant tachycardia, and ventricular tachycardia.
3) It provides guidance on therapies for different tachycardias, such as electrical or chemical cardioversion, rate control, and ablation. The importance of correctly diagnosing wide complex tachycard
This document discusses supraventricular tachycardias (SVT). It defines different types of SVT including paroxysmal SVT, which is common in emergency rooms. Quality of life is often poor for those with paroxysmal SVT. The document discusses mechanisms of SVT including reentry circuits, enhanced automaticity, and triggered activity. It provides details on differentiating AV nodal reentrant tachycardia from AV reentrant tachycardia using electrocardiogram findings. Treatment options discussed include carotid sinus massage, adenosine, and catheter ablation.
Hemoglobin is a tetramer composed of two alpha and two beta subunits that carries oxygen in red blood cells. Each subunit contains an iron molecule that binds oxygen. Hemoglobin picks up oxygen in the lungs and delivers it to tissues while maintaining a high oxygen affinity in the lungs and low affinity in tissues. Variations in hemoglobin structure can result in hemoglobinopathies like sickle cell anemia, where the abnormal hemoglobin polymerizes and causes red blood cells to sickle.
This document summarizes information about cyanide poisoning. It discusses that cyanide inhibits cellular respiration by binding to cytochrome oxidase, stopping ATP production and oxygen utilization. Symptoms occur rapidly and include headache, weakness, confusion and potentially seizures or death. Treatment involves giving methemoglobin generators like methylene blue or sodium nitrite to bind cyanide, followed by thiosulfate to convert it to non-toxic thiocyanate. Oxygen may help displace cyanide but is not a specific antidote. Prompt treatment is needed given cyanide's fast mechanism of toxicity.
The document discusses idiosyncratic reactions to anesthetics and their prevention. It defines idiosyncrasy as an individual's unique abnormal reaction to a particular drug that is genetically determined and unrelated to pharmacology or dosage. Some examples provided include prolonged paralysis from suxamethonium due to enzyme deficiency and reactions to carbamazepine and chloroquine. Prevention focuses on avoiding drugs previously causing reactions, slow injection, and close patient observation.
This document discusses thalassemia, a genetic blood disorder characterized by defective hemoglobin synthesis. There are two main types: alpha thalassemia involves defective alpha chain synthesis while beta thalassemia involves defective beta chain synthesis. Thalassemia major is the severe homozygous form while thalassemia minor is the milder heterozygous form. Symptoms include anemia, jaundice, enlarged liver and spleen, and bone changes from extramedullary hematopoiesis such as bone deformities and growth arrest lines. Management involves blood transfusions and iron chelation therapy.
This document discusses the pathogenesis and laboratory diagnosis of sickle cell anemia and thalassemia. It describes how abnormal red blood cells are destroyed in the spleen, releasing hemoglobin. The heme portion of hemoglobin is broken down into bilirubin and stored iron, while the globin portion is recycled to amino acids. This leads to anemia. Specific tests are used to diagnose these conditions based on abnormal hemoglobin levels, types or variants seen on electrophoresis or peripheral smears. Genetic testing can also identify mutations that cause these hemolytic anemias.
This document provides an overview of tachyarrhythmias, including:
- Definitions of tachyarrhythmias as disturbances in heart rhythm over 100 beats per minute.
- Anatomy and electrophysiology of the heart's conduction system.
- Mechanisms of arrhythmogenesis including disorders of impulse formation and conduction.
- Diagnostic approach involving history, physical exam, ECGs, monitoring, and invasive studies.
- Treatment modalities including antiarrhythmic drugs and ablation procedures for various specific arrhythmias like atrial fibrillation, supraventricular tachycardias, and ventricular arrhythmias.
This document provides an overview of evaluating and treating different types of tachycardia, including:
1) It discusses evaluating the patient's hemodynamic stability, history, and ECG to determine the characteristics and cause of the tachycardia.
2) It describes differentiating between narrow and wide complex tachycardias, and the differential diagnoses for each, including sinus tachycardia, atrial fibrillation, AV nodal reentrant tachycardia, and ventricular tachycardia.
3) It provides guidance on therapies for different tachycardias, such as electrical or chemical cardioversion, rate control, and ablation. The importance of correctly diagnosing wide complex tachycard
This document discusses supraventricular tachycardias (SVT). It defines different types of SVT including paroxysmal SVT, which is common in emergency rooms. Quality of life is often poor for those with paroxysmal SVT. The document discusses mechanisms of SVT including reentry circuits, enhanced automaticity, and triggered activity. It provides details on differentiating AV nodal reentrant tachycardia from AV reentrant tachycardia using electrocardiogram findings. Treatment options discussed include carotid sinus massage, adenosine, and catheter ablation.
Hemoglobin is a tetramer composed of two alpha and two beta subunits that carries oxygen in red blood cells. Each subunit contains an iron molecule that binds oxygen. Hemoglobin picks up oxygen in the lungs and delivers it to tissues while maintaining a high oxygen affinity in the lungs and low affinity in tissues. Variations in hemoglobin structure can result in hemoglobinopathies like sickle cell anemia, where the abnormal hemoglobin polymerizes and causes red blood cells to sickle.
This document summarizes information about cyanide poisoning. It discusses that cyanide inhibits cellular respiration by binding to cytochrome oxidase, stopping ATP production and oxygen utilization. Symptoms occur rapidly and include headache, weakness, confusion and potentially seizures or death. Treatment involves giving methemoglobin generators like methylene blue or sodium nitrite to bind cyanide, followed by thiosulfate to convert it to non-toxic thiocyanate. Oxygen may help displace cyanide but is not a specific antidote. Prompt treatment is needed given cyanide's fast mechanism of toxicity.
2. Methemoglobin a/ Hb abnormal yg
kehilangan kemampuan mengikat
oksigen krn ferronya teroksidasi
menjadi ferri sehingga tdk dpt
membawa oksigen ke jaringan.
Nilai normal Methemoglobin <1%
3. Jalur utama reduksi enzimatik dari produk
NAD NADH
Donor elektron dlm reduksi ferri
metHb ferro
Enzim ini diperlukan u/ reduksi
NAD & metHb
4. Dlm eritrosit proses reduksi enzimatik
metHb dicapai melalui reduksi NADP
yg dihasilkan o/ jalur heksosa
monofosfat.
NADPH agen pereduksi dlm konversi
tergantung dari enzim metHb dgn
Hb. Perannya sangat kecil u/ reduksi
harian metHb
5. Obat yg dapat mengkonversi Hb MetHb
Nitrat
Klorat
Quinin
Phenacetin
Sulfonamide
Pewarna anilin
Anastesi lokal
7. Prinsip percobaan
Nilai absorbansi spectrum methemoglobin
itu kecil (630 - 635 nm) :
penambahan cyanamide : menghilangkan
puncak spectrum absorbansi dengan
mengkonversi methemoglobin menjadi
cyanmethemoglobin. Penurunan absorbansi
sebanding dengan konsentrasi Hb
8. ...
Nilai absorbansi spectrum oxyhemoglobin
itu sangat kecil (> 600 nm) :
- Jika sulfhemoglobin terdapat pada
hemolysate : terjadi peningkatan kurva
absorbsi sekitar 600 – 620 nm.
- Nilai stabil sulfhemoglobin tidak
terpengaruh cyanida
11. Spesimen
Dara segar yg diberikan antikoagulan dgn
heparin, EDTA atau ACD (Acid Citrate
Dextrose).
12. Prosedur
1. Cuvet C1 = 1,5 mL buffer fosfat + 1,5 mL
H2O
2. Tabung reaksi = 0,1 mL darah + 3 mL
H2O Kocok + 0,4 mL buffer potassium
fosfat aduk rata
3. Pindahkan 3 mL hemolisat ke dlm 2
cuvet C2 & C3
13. ...
4. Cuvet C3 = 0,1 mL K3Fe(CN)6 Tutup dgn
parafin, campur dgn membolak-balik sbnyk 3x
& menghitung abs. Pada menit ke 2
5. Menghitung abs. Pada panjang gelombang
630 nm untuk C2 & C3. C1 sebagai blanko
6. SEMUA CUVET = tambahkan KCN
campurkan & diamkan selama 5 menit
7. Hit. Abs. Pada 630 nm