Hemoadsorption to treat severe iatrogenic intoxication with Patent Blue: a case report

• Published in: Journal of medical case reports 2021-02, Vol.15 (1), p.63-63, Article 63
• Main Authors: Taccone, Fabio Silvio, Gardette, Mickael, Creteur, Jacques, Brasseur, Alexandre, Lorent, Sophie, Grimaldi, David
• Format: Article
• Language: English
• Subjects: Acute respiratory distress syndrome; Adult; Cardiac arrhythmia; Case Report; Case reports; Drug dosages; Ecstasy; Extracorporeal Membrane Oxygenation; Female; Hemoadsorption; Hemodynamics; Hemofiltration; Hemoperfusion; Humans; Hypoxia; Iatrogenesis; Iatrogenic Disease; Intellectual property; Intoxication; Medical errors; Methamphetamine; Methylene blue; Multiple organ dysfunction syndrome; Multiple organ failure; Multiple Organ Failure - chemically induced; Multiple Organ Failure - therapy; Ostomy; Patent Blue; Pharmacy; Plasma; Rivaroxaban; Shock; Ticagrelor; Tracheotomy; Tranexamic acid; Weaning
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-020-02657-6

Intoxication with Patent Blue V [sodium compound of (diethylamino-4-phenyl)(hydroxy-5-disulfo-2,4-phenyl) methanol] can lead to high levels of methemoglobin and metabolic acidosis. In severe cases and if not rapidly eliminated from the plasma, this can lead to multiple organ failure and death. A 27-year-old Asian woman (original from Vietnam) was admitted after ecstasy intoxication resulting in multi-organ failure (acute respiratory distress syndrome, metabolic acidosis, capillary leakage syndrome, renal failure, shock refractory to standard resuscitation). As a consequence, continuous renal replacement therapy and veno-venous extracorporeal membrane oxygenation were started. Methylene blue administration to reverse vasoplegia was decided, but unfortunately, Patent Blue V was erroneously administered, resulting in a severe clinical picture of methemoglobinemia and tissue hypoxia. As a therapeutic intervention, CytoSorb hemoadsorption was initiated, and rapid and significant reduction in plasma methemoglobin, accompanied by improved hemodynamics and normalization in plasma lactate levels, was observed. This is the first case describing the application of CytoSorb hemoadsorption in a patient with ecstasy intoxication complicated by iatrogenic administration of Patent Blue V. There is a potential role for CytoSorb in drug intoxication, which needs to be confirmed in larger series.