Sulfohemoglobinemia secundaria a zopiclona. Casos clínicos / Sulfhemoglobinemia secondary to the use of zopiclone. Report of two cases

Sulfhemoglobin (SulfHb) is formed by hemoglobin (Hb) oxidation by sulfur compounds. Sulfhemoglobinemia is mainly associated with drugs or intestinal bacterial overgrowth. Patients present with central cyanosis, an abnormal pulse oximetry and normal arterial oxygen partial pressure. These features are shared with methemoglobinemia (MetHb) whose diagnosis requires an arterial co-oximetry. Depending on the device used, SulfHb may produce interference with this technique. We report two females aged 31 and 43 years, consulting at the emergency room with cyanosis. Both had a history of acute and chronic, high dose zopiclone ingestion. Pulse oximetry showed desaturation but with normal arterial oxygen partial pressure. Cardiac and pulmonary diseases were ruled out. Co-oximetry in two different analyzers showed interference or normal MetHb percentages. No other complications ensued, and cyanosis decreased over days. Since MetHb was discarded among other causes of cyanosis in a compatible clinical context, the diagnosis of sulfhemoglobinemia was made. The confirmatory method is not available in Chile. The presence of SulfHb is difficult to diagnose, confirmatory tests are not readily available, and it frequently interferes with arterial co-oximetry. This is attributed to a similar absorbance peak of both pigments in arterial blood. Venous co-oximetry can be useful in this context. SulfHb is a self-limited condition in most cases, however it must be differentiated from methemoglobinemia to avoid inappropriate treatments like methylene blue.

Influence of sodium nitrite exposure on sulfhemoglobin and hydroxyl radicals in mice / 中华劳动卫生职业病杂志

Objective@#To investigate the influence of sodium nitrite exposure on sulfhemoglobin and hydroxyl radicals in mice.@*Methods@#A total of 60 mice were randomly divided into low-, middle-, and high-dose groups (the concentrations of sodium nitrite were 0.055 mg/ml, 0.110 mg/ml, and 0.220 mg/ml, respectively) and control group (treated with distilled water) , with 15 mice in each group (male/female ratio=1: 1) . A free-drink model was applied and the duration of exposure was 2 weeks. The body weight of all mice was recorded before exposure and at weeks 1 and 2 of exposure. At the end of exposure, the mice were treated with intraperitoneally injected sodium salicylate to capture the hydroxyl radicals and produce 2, 5-dihydroxybenzoic acid and 2, 3-dihydroxybenzoic acid, and high-performance liquid chromatography was used to measure their content. Spectrophotometry was used to measure the relative content of sulfhemoglobin.@*Results@#At week 2 of exposure, the low-, middle-, and high-dose groups had significantly lower body weight than the control group (22.8±2.8 g/21.6±2.8 g/21.2±3.0 g vs 25.6±2.2 g, P<0.05) . The low-, middle-, and high-dose groups had a significantly higher total content of hydroxyl radicals than the control group[ (0.015 3±0.006 5) μg/ml, (0.016 4±0.017 2) μg/ml, and (0.062 7±0.091 0) μg/ml vs (0.009 ±0.007 3) μg/ml, P<0.05]. The relative content of sulfhemoglobin was 1.54%±0.73%, 2.22%±0.44%, and 2.80%±0.69%, respectively, in the low-, middle-, and high-dose groups, and the middle- and high-dose groups had a significant increase in the relative content of sulfhemoglobin compared with the control group (2.22%±0.44%/2.80%±0.69% vs 1.76%±0.60%, P<0.05) . The content of hydroxyl radicals was positively correlated with the relative content of sulfhemoglobin (r=0.837, P<0.05) .@*Conclusion@#Sodium nitrite exposure can increase the content of sulfhemoglobin and hydroxyl radicals in blood, and there is a positive correlation between them.