ABSTRACT
Acquired methemoglobinaemia is a relatively rare condition and, therefore infrequently encountered in acute medical practice. Suspicion of the condition may be triggered when the measured PaO2 is 'out of keeping' with the oxygen saturations that are discovered with pulse oximetry. We describe two separate cases of acquired methemoglobinaemia secondary to the recreational use of alkyl nitrites ['poppers']. The patients presented at separate times to two different teaching hospitals in London, UK. The similarity of these cases has led the authors to conclude that a raised awareness of this potentially fatal condition, and its association with a widely-available recreational drug, is necessary to ensure a correct and timely diagnosis
ABSTRACT
To study the epidemiology of snake bite patients evaluated at the Royal Hospital, Muscat, Sultanate of Oman, and to study their clinical course and outcome. A retrospective study of 65 adult patients presenting at Royal Hospital following a snake bite from May 2006 to August 2008. The main symptoms were local pain at the bite site [26 patients, 40%] and swelling [17 patients, 26%]. Only five patients [7.7%] had signs of bleeding. After assessment, only 47 of the 65 patients were admitted. White cell count [WCC] was raised in 15 cases [23%] on presentation to the emergency room. Prothrombin time was prolonged in 34 patients [52%] and APTT was prolonged in 25 patients [38%] on presentation. Thirty-six patients received anti-snake venom [antivenom] at a mean time of 8 h after the bite and 4 h after arrival in the emergency department. Patients with deranged coagulation profile needed a mean of fourteen vials of antivenom for correction of the abnormal coagulation profile. Two patients died: both had delayed presentation to the hospital. Patients with envenoming following snakebite should receive antivenom as soon as possible: delayed presentation or administration may be very dangerous. The decision to give antivenom should be initiated as soon as possible after patients' arrival at the Emergency Department and the use of the whole blood clotting test [WBCT] may facilitate the early administration of antivenom