Methemoglobinemia laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
Methemoglobinemia can be diagnosed with several laboratory findings. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
'''ABG Analysis''' | '''ABG Analysis''' | ||
On routine [[ABG analysis]] the [[partial pressure]] of [[oxygen]] ([[PO2]]) value should in normal reference ranges in patients with [[methemoglobinemia]]. The reason lies in the fact that the [[ABG]] value represents the [[oxygen]] content in the [[plasma]], and not the oxygen-carrying capacity of | *On routine [[ABG analysis]] the [[partial pressure]] of [[oxygen]] ([[PO2]]) value should in normal reference ranges in patients with [[methemoglobinemia]]. The reason lies in the fact that the [[ABG]] value represents the [[oxygen]] content in the [[plasma]], and not the [[oxygen-carrying capacity of hemoglobin]].<ref>{{ Rev Bras Anestesiol. 2008 Nov-Dec;58(6):651-64. Methemoglobinemia: from diagnosis to treatment. [Article in English, Portuguese] do Nascimento TS1, Pereira RO, de Mello HL, Costa J.pmid=PMID: 19082413}}</ref> <ref>{{South Med J. 2011 Nov;104(11):757-61. doi: 10.1097/SMJ.0b013e318232139f. | ||
Methemoglobinemia: pathogenesis, diagnosis, and management. | |||
Skold A1, Cosco DL, Klein R. pmid=22024786 }}</ref> <ref>{{Toxicol Rev. 2003;22(1):13-27. | |||
Occupational methaemoglobinaemia. Mechanisms of production, features, diagnosis and management including the use of methylene blue. | |||
Bradberry SM1. pmid=14579544}}</ref> | |||
'''Co-oximetry''' | '''Co-oximetry''' | ||
The [[co-oximeter]] is the most accurate device to measure [[methemoglobin]]. The newer generation devices can actually differentiate between [[methemoglobin]], [[carboxyhemoglobin]], [[oxyhemoglobin]], [[deoxyhemoglobin]], and also | *The [[co-oximeter]] is the most accurate device to measure [[methemoglobin]]. The newer generation devices can actually differentiate between [[methemoglobin]], [[carboxyhemoglobin]], [[oxyhemoglobin]], [[deoxyhemoglobin]], and also [[sulfhemoglobin]].<ref>{{ Anesth Analg. 2010 Jul;111(1):143-8. doi: 10.1213/ANE.0b013e3181c91bb6. Epub 2009 Dec 10. | ||
[[sulfhemoglobin]]. | Accuracy of methemoglobin detection by pulse CO-oximetry during hypoxia. | ||
Feiner JR1, Bickler PE, Mannheimer PD. pmid=20007731}}</ref> | |||
'''Pulse oximetry''' | '''Pulse oximetry''' | ||
The [[pulse oximetry]] in [[methemoglobinemia]] patients will always show a value around 85%, regardless of the level of [[MetHb]] in the blood. This is very importan tot know as this value can be misleading especially in patients with very high [[MetHb]] levels | *The [[pulse oximetry]] in [[methemoglobinemia]] patients will always show a value around 85%, regardless of the level of [[MetHb]] in the blood. This is very importan tot know as this value can be misleading especially in patients with very high [[MetHb]] levels. Fortunately new [[multiwavelength pulse oximeters]] have been developed recently and they can detect the levels of [[MetHb]] more accurately. <ref>{{ Conf Proc IEEE Eng Med Biol Soc. 2017 Jul;2017:4570-4573. doi: 10.1109/EMBC.2017.8037873. Three-wavelength method for the optical differentiation of methemoglobin and sulfhemoglobin in oxygenated blood. | ||
Fortunately new | Van Leeuwen SR, Baranoski GVG, Kimmel BW. pmid=29060914 }}</ref> | ||
In [[methemoglobinemia]] patients we often see the so called “[[saturation gap]]” which can help us diagnose the condition. The gap is calculated by subtracting the [[oxygen]] percentage from the [[ABG analysis]] (typically normal in [[methemoglobinemia]] patients 100%) from the percentage of [[oxygen saturation]] given by the [[pulse oximeter]] (always ~85% in [[methemoglobiemia]] patients). [[Saturaion gap]] more than 5 % is significant. | *In [[methemoglobinemia]] patients we often see the so called “[[saturation gap]]” which can help us diagnose the condition. The gap is calculated by subtracting the [[oxygen]] percentage from the [[ABG analysis]] (typically normal in [[methemoglobinemia]] patients 100%) from the percentage of [[oxygen saturation]] given by the [[pulse oximeter]] (always ~85% in [[methemoglobiemia]] patients). [[Saturaion gap]] more than 5% is significant. | ||
==References== | ==References== | ||
Revision as of 14:41, 15 May 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Template:Aksiniya K. Stevasarova, M.D.
Overview
Methemoglobinemia can be diagnosed with several laboratory findings.
Laboratory Findings
ABG Analysis
- On routine ABG analysis the partial pressure of oxygen (PO2) value should in normal reference ranges in patients with methemoglobinemia. The reason lies in the fact that the ABG value represents the oxygen content in the plasma, and not the oxygen-carrying capacity of hemoglobin.[1] [2] [3]
Co-oximetry
- The co-oximeter is the most accurate device to measure methemoglobin. The newer generation devices can actually differentiate between methemoglobin, carboxyhemoglobin, oxyhemoglobin, deoxyhemoglobin, and also sulfhemoglobin.[4]
Pulse oximetry
- The pulse oximetry in methemoglobinemia patients will always show a value around 85%, regardless of the level of MetHb in the blood. This is very importan tot know as this value can be misleading especially in patients with very high MetHb levels. Fortunately new multiwavelength pulse oximeters have been developed recently and they can detect the levels of MetHb more accurately. [5]
- In methemoglobinemia patients we often see the so called “saturation gap” which can help us diagnose the condition. The gap is calculated by subtracting the oxygen percentage from the ABG analysis (typically normal in methemoglobinemia patients 100%) from the percentage of oxygen saturation given by the pulse oximeter (always ~85% in methemoglobiemia patients). Saturaion gap more than 5% is significant.
References
- ↑ {{ Rev Bras Anestesiol. 2008 Nov-Dec;58(6):651-64. Methemoglobinemia: from diagnosis to treatment. [Article in English, Portuguese] do Nascimento TS1, Pereira RO, de Mello HL, Costa J.pmid=PMID: 19082413}}
- ↑ {{South Med J. 2011 Nov;104(11):757-61. doi: 10.1097/SMJ.0b013e318232139f. Methemoglobinemia: pathogenesis, diagnosis, and management. Skold A1, Cosco DL, Klein R. pmid=22024786 }}
- ↑ {{Toxicol Rev. 2003;22(1):13-27. Occupational methaemoglobinaemia. Mechanisms of production, features, diagnosis and management including the use of methylene blue. Bradberry SM1. pmid=14579544}}
- ↑ {{ Anesth Analg. 2010 Jul;111(1):143-8. doi: 10.1213/ANE.0b013e3181c91bb6. Epub 2009 Dec 10. Accuracy of methemoglobin detection by pulse CO-oximetry during hypoxia. Feiner JR1, Bickler PE, Mannheimer PD. pmid=20007731}}
- ↑ {{ Conf Proc IEEE Eng Med Biol Soc. 2017 Jul;2017:4570-4573. doi: 10.1109/EMBC.2017.8037873. Three-wavelength method for the optical differentiation of methemoglobin and sulfhemoglobin in oxygenated blood. Van Leeuwen SR, Baranoski GVG, Kimmel BW. pmid=29060914 }}