Elevated methaemoglobin in a critically ill patient as a result of hydrogen peroxide exposure: A case study.

WHAT IS KNOWN AND OBJECTIVE: Formation of methaemoglobinaemia (MetHb) decreases oxygen capacity in the blood, leading to tissue hypoxia. This condition may be acquired following exposure to certain drugs. CASE SUMMARY: A critically ill patient with necrotizing fasciitis unexpectedly developed marked and unexplained MetHb (6.7%). Her digital medication list did not reveal the causative factor. However, deeper exploration showed the use of other compounds (acetone, hydrogen peroxide) not routinely visible on the medication list. WHAT IS NEW AND CONCLUSION: Elevated MetHb likely resulted from high-volume hydrogen peroxide 3% exposure. Clinicians should be cautious rinsing large open wounds with hydrogen peroxide. When MetHb is diagnosed, less familiar compounds, usually not on the medication list, should be considered in the differential diagnosis and extensive hetero-anamnesis is mandatory.

Acute teriflunomide overdose with relatively mild symptoms: A case report.

WHAT IS KNOW AND OBJECTIVE: Teriflunomide is indicated for the treatment of adult patients with relapsing-remitting multiple sclerosis. CASE SUMMARY: We present a rare intoxication with a high dose (672 mg) of teriflunomide. According to its product label, the only known treatment is the administration of colestyramine and activated carbon (charcoal). No serious adverse events occurred during the time the patient was admitted (<24 h). No long-term overdose-related symptoms or complaints were reported. WHAT IS NEW AND CONCLUSION: The fact that after the acute overdose both adverse events and laboratory parameters were acceptable, prescribing colestyramine and activated carbon, as well as monitoring of laboratory parameters such as full blood count, liver and kidney values and QTc, seems sufficient during the early stage (<24 h after intake) of teriflunomide overdose.