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  • Title: Whole bowel irrigation in dapsone intoxication with persistent methemoglobinemia.
    Author: Carboni Bisso I, Gemelli N, Cordero MP, Barrios C, Pina D.
    Journal: Am J Emerg Med; 2020 Oct; 38(10):2246.e1-2246.e2. PubMed ID: 32507475.
    Abstract:
    Dapsone intoxication can be a life-threatening condition due its enterohepatic recirculation pharmacokinetics, and therefore, persistent methemoglobinemia development. We describe a case of a 17-year-old girl who was admitted 4 h after ingesting 5 g of dapsone. She presented methemoglobinemia (39%) and showed clinical signs of toxicity (cyanosis and altered mental status) despite mechanical ventilation. Multiple activated charcoal dosis and methylene blue infusions were performed. Notwithstanding initial improvement, a pattern of peaks and valleys was observed in serial methemoglobinemia measurements, with cyclic states of hypoxemia. On account of enterohepatic recirculation pharmacokinetics, clearance was enhanced by whole bowel irrigation. After 7 days of hospitalization, she was discharged in good general condition.
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