Refractory hypoxia and saturation gap in a COVID-19 patient

IF 1.7 Q3 MEDICAL LABORATORY TECHNOLOGY

Practical Laboratory Medicine Pub Date : 2024-04-18 DOI:10.1016/j.plabm.2024.e00395

Abidah Mobarak , Subashini C. Thambiah , Ana Daliela Masiman , Intan Nureslyna Samsudin , Yin Ye Lai

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Abstract

Acquired methemoglobinemia, predominantly due to oxidizing medications occurs when heme iron in hemoglobin is oxidized from ferrous to ferric ion and binds oxygen irreversibly leading to functional anemia, cyanosis, and tissue hypoxia. We report a case of a 60-year-old man with multiple comorbidities who was diagnosed with coronavirus disease 2019 (COVID-19) and developed methemoglobinemia after consumption of prescribed supplements. He presented with dyspnea and cyanosis. An oxygen saturation gap with characteristic chocolate-brown arterial blood indicated methemoglobinemia. Outsourced methemoglobin (MetHb) was increased at 9.0%. Despite aggressive intervention, he succumbed to his illness. In this case, we discuss the pathophysiology of why some individuals, especially the elderly with COVID-19 are more susceptible to develop methemoglobinemia after possibly being exposed to oxidizing agents. Laboratory methods for assessing oxygen saturation, including pulse oximetry, arterial blood gas and co-oximetry are examined in relation to this case. The importance of considering a diagnosis of methemoglobinemia based on clinical and biochemical findings although MetHb assay or co-oximetry are not readily available is also emphasized.

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一名 COVID-19 患者的难治性缺氧和饱和度缺口

当血红蛋白中的血红素铁由亚铁离子氧化为铁离子，并与氧不可逆地结合，导致功能性贫血、紫绀和组织缺氧时，就会发生获得性高铁血红蛋白血症，这主要是由氧化性药物引起的。我们报告了一例 60 岁男性病例，他患有多种并发症，被诊断为冠状病毒病 2019（COVID-19），并在服用处方补品后出现高铁血红蛋白血症。他出现呼吸困难和紫绀。血氧饱和度出现差距，动脉血呈特征性的巧克力棕色，表明出现了高铁血红蛋白血症。外包高铁血红蛋白（MetHb）升高至 9.0%。尽管采取了积极的干预措施，他还是因病去世。在这个病例中，我们讨论了为什么有些人，尤其是患有 COVID-19 的老年人在可能接触氧化剂后更容易患高铁血红蛋白血症的病理生理学原因。结合本病例研究了评估血氧饱和度的实验室方法，包括脉搏血氧仪、动脉血气和联合血氧仪。此外，还强调了根据临床和生化检查结果考虑高铁血红蛋白血症诊断的重要性，尽管 MetHb 检测或联合氧饱和度测定法并不容易获得。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Practical Laboratory Medicine Health Professions-Radiological and Ultrasound Technology

CiteScore

3.50

自引率

0.00%

发文量

审稿时长

7 weeks

期刊介绍： Practical Laboratory Medicine is a high-quality, peer-reviewed, international open-access journal publishing original research, new methods and critical evaluations, case reports and short papers in the fields of clinical chemistry and laboratory medicine. The objective of the journal is to provide practical information of immediate relevance to workers in clinical laboratories. The primary scope of the journal covers clinical chemistry, hematology, molecular biology and genetics relevant to laboratory medicine, microbiology, immunology, therapeutic drug monitoring and toxicology, laboratory management and informatics. We welcome papers which describe critical evaluations of biomarkers and their role in the diagnosis and treatment of clinically significant disease, validation of commercial and in-house IVD methods, method comparisons, interference reports, the development of new reagents and reference materials, reference range studies and regulatory compliance reports. Manuscripts describing the development of new methods applicable to laboratory medicine (including point-of-care testing) are particularly encouraged, even if preliminary or small scale.