Dapsone Hypersensitivity Syndrome In An Adolescent During Treatment Of Leprosy

A 12 y old girl was admitted 24 days after start a WHO multidrug therapy scheme for multibacillary leprosy (dapsone, clofazimine and rifampicin) with intense jaundice, generalized lymphadenopathy, hepatoesplenomegaly, oral erosions, conjunctivitis, morbiliform rash and edema of face, ankles and hands. The main laboratory data on admission included: hemoglobin, 8.4 g/dL; WBC, 15,710 cells/mm3; platelet count, 100,000 cells/mm3; INR = 1.49; increased serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transpeptidase, alkaline phosphatase, direct and indirect bilirubin. Following, the clinical conditions had deteriorated, developing exfoliative dermatitis, shock, generalized edema, acute renal and hepatic failure, pancytopenia, intestinal bleeding, pneumonia, urinary tract infection and bacteremia, needing adrenergic drugs, replacement of fluids and blood product components, and antibiotics. Ten days after admission she started to improve, and was discharged to home at day 39th, after start new supervised treatment for leprosy with clofazimine and rifampicin, without adverse effects. This presentation fulfils the criteria for the diagnosis of dapsone hypersensitivity syndrome (fever, generalized lymphadenopathy, exfoliative rash, anemia and liver involvement with mixed hepatocellular and cholestatic features). Physicians, mainly in geographical areas with high prevalence rates of leprosy, should be aware to this severe, and probably not so rare, hypersensitivity reaction to dapsone.466331334Aldday, E.J., Barnes, J., Toxic effects of diaminodiphenylsulphone in leprosy (1951) Lancet, 2, pp. 205-206Andrade, Z.M.V., França, E.R., Teixeira, M.A.G., Santo, I.B., Síndrome sulfônica: Relato de um caso (1999) An. Bras. Derm., 74, pp. 59-61Barbosa, A.M., Martins Jr., E., Fleury, R.N., Opromolla, D.V.A., Mais um caso de síndrome da sulfona (2000) Hansenol. Int., 25, pp. 159-162Bluhm, R.E., Adedoyin, A., Mccarver, D.G., Branch, R.A., Development of dapsone toxicity in patients with inflammatory dermatoses: Activity of acetylation and hydroxylation of dapsone as risk factors (1999) Clin. Pharmacol. Ther., 65, pp. 598-605Bocquet, H., Bourgault-Villada, I., Delfau-Larue, M.H., Syndrome d'hypersensibilité à la dapsone. Clone T circulant transitoire (1995) Ann. Derm. Vénér., 122, pp. 514-516Brasil, M.T.L.R.F., Opromolla, D.V., Marzliak, M.L.C., Nogueira, W., Results of a surveillance system for adverse effects in leprosy's WHO/MDT (1996) Int. J. Leprosy, 64, pp. 97-104Chalasani, P., Baffoe-Bonnie, H., Jurado, R.I., Dapsone therapy causing sulfone syndrome and lethal hepatic failure in an HIV-infected patient (1994) Sth. Med. J., 87, pp. 1145-1146Frey, H.M., Gershon, A.A., Borkowsky, W., Bullock, W.E., Fatal reaction to dapsone during treatment of leprosy (1981) Ann. Intern. Med., 94, pp. 777-779Gallo, M.E.N., Nery, J.A.C., Garcia, C.G., Interconências pelas drogas utilizadas nos esquemas poliquimioterápicos em hanseníase (1995) Hansenol. Int., 20, pp. 46-50Johnson, D.A., Cattau Jr., E.L., Kurltsky, J.N., Zimmerman, H.J., Liver involvement in the sulfone syndrome (1986) Arch. Intern. Med., 146, pp. 875-877Kaluarachchi, S.I., Fernandopulle, B.M., Gunawardane, B.P., Hepatic and haematological adverse reactions associated with the use of multidrug therapy in leprosy: A five year retrospective study (2001) Indian J. Leprosy, 73, pp. 121-129Kumar, R.H., Kumar, M.V., Thappa, D.M., Dapsone syndrome: A five year retrospective analysis (1998) Indian J. Leprosy, 70, pp. 271-276Lastória, J.C., De Mello, M.S., Putinatti, A., Souza, V., Síndrome de hipersensibilidade à dapsona (2004) Diagn. Tratam., 9, pp. 19-21Leta, G.C., Simas, M.E.P.A.S., Oliveira, M.L.W., Gomes, M.K., Síndrome de hipersensibilidade à dapsona: Revisão sistemática dos critérios diagnósticos (2003) Hansenol. Int., 28, pp. 79-84Lowe, J., Treatment of leprosy with diamino diphenylsulphone by mouth (1950) Lancet, 1, pp. 145-150Mandell, G.L., Petri Jr., W.A., Drugs used in the chemotherapy of tuberculosis, Mycobacterium avlum complex disease and leprosy (1996) Goodman & Gilman's Pharmacological Basis of Therapeutics. 9. International Ed., pp. 1155-1174. , Hardman, J.G.Limbird, L.E.Molinoff, P.B.Ruddon, R.W. & Gilman, A.G., ed. New York, McGraw HillOpromolla, D.V.A., Fleury, R.N., Sindrome da sulfona e reação reversa (1994) Hansenol. Int., 19, pp. 70-76Prussik, R., Shear, N.H., Dapsone hypersensitivity syndrome (1996) J. Amer. Acad. Derm., 35, pp. 346-349Rao, P.N., Lakshmi, T.S., Increase in the incidence of dapsone hypersensitivity syndrome: An appraisal (2001) Leprosy Rev., 72, pp. 57-62Reeve, P.A., Ala, J.L., Hall, J.J., Dapsone syndrome in Vanuatu: A high incidence during multidrug treatment (MDT) of leprosy (1992) J. Trop. Med. Hyg., 95, pp. 266-270Risse, L., Bernard, P., Brosset, A., Syndrome d'hypersensibilitȩ a la disulone® (1994) Ann. Derm. Vȩnȩr., 121, pp. 242-244Saito, S., Ikezawa, Z., Miyamoto, H., Kim, S., A case of dapsone syndrome (1994) Clin. Exp. Derm., 19, pp. 152-156Santos, M.E., Leta, G.C., Oliveira, M.L.W., Dapsone hypersensitivity syndrome (DHS): Not so rare to be minimized in endemic countries (2002) International Leprosy Congress, 16 (PART 16). , Salvador, Brazil. Book of abstractsThong, B.Y., Leong, K.P., Chng, H.H., Hypersensitivity syndrome associated with dapsone/pyrimethamine (Maloprim) antimalaria chemoprophylaxis (2002) Ann. Allergy Asthma Immunol., 88, pp. 527-529Tomecki, K.J., Catalano, C.J., Dapsone hypersensitivity. The sulfone syndrome revisited (1981) Arch. Derm., 117, pp. 38-39(2004) Leprosy Elimination Project. Status Report, 2003, , http://www.who.int/lep/Reports/s20042.pdf, WHO, Genev

Disponibilidade De Antídotos No Município De Campinas, São Paulo

The lack of availability of antidotes in emergency services is a worldwide concern. The aim of the present study was to evaluate the availability of antidotes used for treating poisoning in Campinas (SP). DESIGN AND SETTING: This was a cross-sectional study of emergency services in Campinas, conducted in 2010-2012. METHODS: The availability, amount in stock, place of storage and access time for 26 antidotal treatments was investigated. In the hospitals, the availability of at least one complete treatment for a 70 kg adult over the first 24 hours of admission was evaluated based on stock and access recommendations contained in two international guidelines. RESULTS: 14 out of 17 functioning emergency services participated in the study, comprising pre-hospital services such as the public emergency ambulance service (SAMU; n = 1) and public emergency rooms for admissions lasting ≤ 24 hours (UPAs; n = 3), and 10 hospitals with emergency services. Six antidotes (atropine, sodium bicarbonate, diazepam, phytomenadione, flumazenil and calcium gluconate) were stocked in all the services, followed by 13 units that also stocked activated charcoal, naloxone and diphenhydramine or biperiden. No service stocked all of the recommended antidotes; only the regional Poison Control Center had stocks close to recommended (22/26 antidotal treatments). The 10 hospitals had almost half of the antidotes for starting treatments, but only one quarter of the antidotes was present with stocks sufficient for providing treatment for 24 hours. CONCLUSION: The stock of antidotes for attending poisoning emergencies in the municipality of Campinas is incomplete and needs to be improved. © 2017, Associacao Paulista de Medicina. All rights reserved.13511522FAPEAM, Fundação de Amparo à Pesquisa do Estado do Amazona

Snakebites By Bothrops Spp In Children In Campinas, São Paulo, Brazil.

From January, 1984 to March, 1999, 73 children under 15 y old (ages 1-14 y, median 9 y) were admitted after being bitten by snakes of the genus Bothrops. Twenty-six percent of the children were classified as mild envenoming, 50.7% as moderate envenoming and 20.6% as severe envenoming. Two patients (2.7%) showed no signs of envenoming. Most of the patients presented local manifestations, mainly edema (94.5%), pain (94.5%) ecchymosis (73.9%) and blisters (11%). Local and/or systemic bleeding was observed in 28.8% of the patients. Before antivenom (AV) administration, blood coagulation disorders were observed in 60.7% (incoagulable blood in 39.3%) of the 56 children that received AV only in our hospital. AV early reactions, most of which were considered mild, were observed in 44.6% of these cases (in 15/30 patients not pretreated and in 10/26 patients pretreated with hydrocortisone and histamine H1 and H2 antagonists). The main clinical complications observed were local infection (15.1%), compartment syndrome (4.1%), gangrene (1.4%) and acute renal failure (1.4%). No deaths were recorded. There were no significant differences with regard to severity of envenoming versus the frequency of blood coagulation disorders among the three categories of envenoming (p = 0.75) or in the frequency of patients with AV early reactions between the groups that were and were not pretreated (p = 0.55). The frequency of local infection was significantly greater in severe cases (p < 0.001). Patients admitted more than 6 h after the bite had a higher risk of developing severe envenoming (p = 0.04).43329-3

A Clinico-epidemiological Study Of Bites By Spiders Of The Genus Phoneutrla

From January, 1984 to December, 1996, 422 patients (ages 9 m-99 y, median 29 y) were admitted after being bitten by spiders which were brought and identified as Phoneutria spp. Most of the bites occurred at March and April months (29.2%), in the houses (54.5%), during the day (76.5%), and in the limbs (feet 40.9%, hands 34.3%). Upon hospital admission, most patients presented only local complaints, mainly pain (92.1%) and edema (33.1%) and were classified as presenting mild (89.8%), moderate (8.5%) and severe (0.5%) envenomation. Few patients (1.2%) did not present signs of envenomation. Severe accidents were only confirmed in two children (9 m, 3 y). Both developed acute pulmonary edema, and the older died 9 h after the accident. Patients more than 70 yearold had a significantly greater (p<0.05) frequency of moderate envenomations compared to the 10-70-year-old individuals. Proceedings to relief local pain were frequently performed (local anesthesia alone 32.0%, local anesthesia plus analgesics 20.6% and oral analgesics alone 25.1%). Only 2.3% of the patients (two cases classified as severe and eight as noderate, eight of them in children) were treated with i.v. antiarachnid antivenom. No antivenom early reaction was observed. In conclusion, accidents involving the genus Phoneutria are common in the region of Campinas, with the highest risk groups being children under 10 years of age and adults over 70 years of age. Cases of serious envenomation are rare (0.5%).4211721Antunes, E., Marangoni, R.A., Brain, S.D., De Nucci, G., Phoneutria nigriventer (armed spider) venom induces increased vascular permeability in rat and rabbit skin in vivo (1992) Toxlcon, 30, pp. 1011-1016Antunes, E., Marangoni, R.A., Borges, N.C.C.T., Effects of Phoneutria nigriventer venom on rabbit vascular smooth muscle (1993) Braz. J. Med. Biol. Res., 26, pp. 81-91Bucaretchi, F.-., (1990) Análise das Principais Diferenças Clinicas e Epidemiológicas Dos Acidentes Por Escorplões Das Espécies Tityus Serrulatus e Tityus Bahiensis, e Por Aranhas do Gẽnero Phoneutria, Atendidos no CCI-HC-UNICAMP, no Período de Janeiro de 1984 a Julho de 1988, , Campinas, Dissertação de Mestrado -Faculdade de Ciẽncias Médicas da Universidade Estadual de CampinasBucaretchi, F., Acidentes por Phoneutria (1992) Plantas Venenosas e Animals Peçonhentos, pp. 196-201. , SCHVARTSMAN, S., ed. Sãu Paulo, SarvierBucaretchi, F., Collares, E.F., Effect of Phoneutria nigriventer spider venom on gastric emptying in rats (1996) Braz. J. Med. Biol. Res., 29, pp. 205-211Bücherl, W., A "armadeira": A aranha mais perigosa do mundo! (1985) Acúleos Que Matam, pp. 35-45. , BÜCHERL. W., ed. Rio De Janeiro. KosmosCosta, S.K.P., Moreno, J.R.H., Brain, S.D., The effect of Phoneutria nigriventer (armed spider) venom on arterial blood pressure of anaesthetised rats (1996) Europ. J. Pharmacol., 298, pp. 113-120Cruz-Hofling, M.A., Love, S., Brook, G., Duchen, L.W., Effects of Phoneutria nigriveter spider venom on mouse peripheral nerve (1985) Quart. J, Exp. Physlol., 70, pp. 623-640Fontana, M.D., Vital-Brazil, O., Mode of action of Phoneutria nigriventer spider venom at the isolated phrenic nerve-diaphragm of the rat (1985) Braz. J. Med. Biol. Res., 18, pp. 557-565Lopes-Martins, R.A.B., Antune, S.E., Oliva, M.L.V., Pharmacological characterization of rabbit corpus cavernosum relaxation mediated by the tissue kallikrein-kinin system (1994) Brit. J. Pharmacol., 113, pp. 81-86Lucas, M.S., Spiders in Brazil (1988) Toxicon, 26, pp. 759-772Marangoni, R.A., Antunes, E., Brain, S.D., De-Nucci, G., Activation by Phoneutria nigriventer (armed spider) venom of the tissue kallikrein-kininogen-kinin system in rabbit skin in viva (1993) Brit. J. Pharmacol., 109, pp. 539-543Acidentes por Phoneutria (1998) Manual de Diagnóstico e Tratamento de Acidentes Por Animals Peçonhentos, pp. 54-56. , Brasflia, Ministério da Saúde/Fundação Nacional da SaúdeAraneísmo (1998) Manual de Diagnóstico e Tratamento de Acidentes Por Animals Peçonhentos, pp. 49-53. , Brasfia, Ministério da Saúde/Fundação Nacional da SaúdeRamos, E.F., Almeida, C.E., Gouvêa, E., Carmo-Silva, M., Considernções sobre a atividade de locomoção, preferência por ecótopos e aspectos territoriais de phoneutria nigriventer (Keiserling, 1891) (1998) Rev. Bras. Biol., 58, pp. 71-78. , Aranae. CtenidaeRego, E., Bento, A.C., Lopes-Martins, A.B., Isolation and partial characterization of a polypeptide from Phoneutria nigriventer spider venom that relaxes rabbit corpus cavernosum in vitro (1996) Toxicon, 34, pp. 1141-1147Rosenfeld, G., Animais peçonhentos e tóxicos do Brasil (1972) Introdução à Geografia Médica do Brasil, pp. 430-475. , LACAZ. C.S.: BARUZZI, R.G. & SIQUEIRA Jr., W., ed. São Paulo, EDUSPVellard, J., Les araignées vraies. Les ctènes (1936) Le Venin des Araignèes. Monographies de L'institut Pasteur, pp. 169-184. , VELLARD, J., ed. Paris. MassonVital-Brazil, Vellard, J., Contribuição ao estudo do veneno das aranhas. II. Mem. Inst (1926) Butantan, 2, pp. 3-77Vital-Brazil, O., Bernardo-Leite, G.B., Fontana, M., Modo de ação da peçonha da aranha armadeira, phoneutria nigriventer (Keiserling, 1891), nas aurífculas isoladas de cobain (1988) Ciênc. Cult., 40, pp. 181-18

Self-medication In Children And Adolescents [automedicação Em Crianças E Adolescentes]

Objective: To determine the prevalence of self-medication in children and adolescents in the municipalities of Limeira and Piracicaba, state of São Paulo, and to correlate results with sociodemographic indicators and with the use of health care services (public or private). Methods: Descriptive population-based study of a simple random sample from the two municipalities, comprised of 772 inhabitants from 85 urban census sectors selected through cluster sampling. Inclusion criteria: age ≤ 18 years; interview with one parent/tutor; consumption of at least one drug in the previous 15 days. Subjects were divided into two study groups according to their pattern of drug use: self-medication (lay advice) and medical prescription. Linear association tests, descriptive analysis of variables and multiple logistic regression tests were carried out to analyze data. Results: The prevalence of self-medication was 56.6%. Mothers (51%) and drugstore employees (20.1%) were most frequently responsible for self-medication. The main groups of self-prescribed drugs were: analgesic/antipyretic and non-hormonal anti-inflammatory drugs (52.9%); drugs acting on the respiratory tract (15.4%) and gastrointestinal drugs (9.6%); and systemic antibiotics (8.6%). The situation that most commonly motivated self-medication were respiratory diseases (17.2%), fever (15%), and headache (14%). Subjects in the age group of 7-18 years (odds ratio = 2.81) and public health care users (odds ratio = 1.52) showed increased risk for self-medication. Conclusions: The prevalence of self-medication in children and adolescents was high, which reinforces the need for public health interventions aiming at preventing this practice. Copyright © 2007 by Sociedade Brasileira de Pediatria.835453458Paulo LG, Zanini AC. Automedicação no Brasil. Rev Ass Med Bras. 1988;34:69-75Arrais, P.S., Coelho, H.L., Batista, M.C., Carvalho, M.L., Righi, R.E., Arnau, J.M., Perfil da automedicação no Brasil (1997) Rev Saude Publica, 31, pp. 71-77Drug Utilization Research Group, Latin America (1997) Clin Pharmacol Ther, 61, pp. 488-493. , Multicenter study on self-medication and self-prescription in six Latin American countriesLaporte, J.R., (1993) Principios de epidemiología del medicamento, , 2 ed. Barcelona: Masson;Dukes MN. Drug utilization studies. Methods and uses. Introduction. WHO Reg Publ Eur Ser. 1993;45:1-4Carvalho, M.F., Pascom, A.R., Souza-Junior, P.R., Damacena, G.N., Szwarcwald, C.L., Utilization of medicines by the Brazilian population, 2003 (2005) Cad Saude Publica, 21 (SUPPL.), pp. 100-108Béria, J.U., Victora, C.G., Barros, F.C., Teixeira, A.B., Lombardi, C., Epidemiologia do consumo de medicamentos em crianças de centro urbano da região sul do Brasil (1993) Rev Saude Publica, 27, pp. 95-104Urbano, B., Magro, R., Masip, M., Vacas, R., Automedicación en pediatría general (1994) Atención Primaria, 13, pp. 313-316Bricks, L.F., Leone, C., Utilização de medicamentos por crianças atendidas em creches (1996) Rev Saude Publica, 30, pp. 527-535Weiderpass, E., Béria, J.U., Barros, F.C., Victoria, C.G., Tomasi, E., Halpern, R., Epidemiologia do consumo de medicamentos no primeiro trimestre de vida em centro urbano do sul do Brasil (1998) Rev Saude Publica, 32, pp. 335-344Gomes, M.F.S., (2000) Estudo da automedicação infantil em uma região administrativa no município do, , Rio de Janeiro [dissertação, Rio de Janeiro: Universidade Federal do Rio de JaneiroBricks, L.F., Uso judicioso de medicamentos em crianças (2003) J Pediatr (Rio J), 79 (SUPPL. 1), pp. S107-S114da Silva, C.H., Giugliani, E.R., Consumo de medicamentos em adolescentes escolares: Uma preocupação (2004) J Pediatr (Rio J), 80, pp. 326-332Johnson, R.E., Pope, C.R., Health status and social factors in nonprescribed drug use (1983) Med Care, 21, pp. 225-233Lefévre, F., A função simbólica dos medicamentos (1983) Rev Saude Publica, 15, pp. 500-503Fabricant, S., Hirschhorn, N., Deranged distribution, perverse prescription, unprotected use: The irrationality of pharmaceuticals in the developing world (1987) Health Policy Plan, 2, pp. 204-213Segall, A., A community survey of self-medication activities (1990) Med Care, 28, pp. 301-310Laporte, J.R., Automedicación: La información de los usuarios aumenta al mismo tiempo que el consumo? (1997) Med Clin (Barc), 109, pp. 795-796Kennedy, J.G., Over the counter drugs (1996) BMJ, 312, pp. 593-594Bradley, C., Blenkinsopp, A., Over the counter drugs: The future of self medication (1996) BMJ, 312, pp. 835-837Lowe, N.K., Ryan-Wenger, N.M., Over-the-counter medications and self-care (1999) Nurse Pract, 24, pp. 34-44(2007) WHOCollaborating Centre for Drug Statistic Methodology [banco de dados na Internet]. ATC/DDD Index, , http://www.whocc.no/ atcddd, Disponível em:, Access: 28/06/2007Mattar, F.N., Análise crítica dos estudos de estratificação socioeconômica da ABA-Abipeme (1995) Rev Adm, 30, pp. 57-74The R Project for Statistical Computing [site na Internet], , http://www.r-project.org, Disponível em: Access: 20/06/2007Vilarino, J.F., Soares, I.C., Silveira, C.M., Rödel, A.P., Bortoli, R., Lemos, R.R., Perfil da automedicação em município do Sul do Brasil (1998) Rev Saude Publica, 32, pp. 43-49Schirm, E., van den Berg, P., Gebben, H., Sauer, P., De Jong-van den Berg, L., Drug use of children in the community assessed through pharmacy dispensing data (2000) Br J Clin Pharmacol, 50, pp. 473-478Loyola Filho, A.I., Uchoa, E., Guerra, H.L., Firmo, J.O., Lima-Costa, M.F., Prevalência e fatores associados à automedicação: Resultados do Projeto Bambuí (2002) Rev Saude Publica, 36, pp. 55-62Martins, A.P., Miranda Ada, C., Mendes, Z., Soares, M.A., Ferreira, P., Nogueira, A., Self-medication in a Portuguese urban population: A prevalence study (2002) Pharmacoepidemiol Drug Saf, 11, pp. 409-41

A Clinico-epidemiological Study Of Bites By Spiders Of The Genus Phoneutria.

From January, 1984 to December, 1996, 422 patients (ages 9 m-99 y, median 29 y) were admitted after being bitten by spiders which were brought and identified as Phoneutria spp. Most of the bites occurred at March and April months (29.2%), in the houses (54.5%), during the day (76.5%), and in the limbs (feet 40.9%, hands 34.3%). Upon hospital admission, most patients presented only local complaints, mainly pain (92.1%) and edema (33.1%) and were classified as presenting mild (89.8%), moderate (8.5%) and severe (0.5%) envenomation. Few patients (1.2%) did not present signs of envenomation. Severe accidents were only confirmed in two children (9 m, 3 y). Both developed acute pulmonary edema, and the older died 9 h after the accident. Patients more than 70 year-old had a significantly greater (p<0.05) frequency of moderate envenomations compared to the 10-70-year-old individuals. Proceedings to relief local pain were frequently performed (local anesthesia alone 32.0%, local anesthesia plus analgesics 20.6% and oral analgesics alone 25. 1%). Only 2.3% of the patients (two cases classified as severe and eight as moderate, eight of them in children) were treated with i.v. antiarachnid antivenom. No antivenom early reaction was observed. In conclusion, accidents involving the genus Phoneutria are common in the region of Campinas, with the highest risk groups being children under 10 years of age and adults over 70 years of age. Cases of serious envenomation are rare (0.5%).4217-2

Finger Burns Caused By Concentrated Hydrofluoric Acid, Treated With Intra-arterial Calcium Gluconate Infusion: Case Report [queimadura Digital Por ácido Fluorídrico Concentrado Tratada Com Infusão Intra-arterial De Gluconato De Cálcio: Relato De Caso]

Context: Hydrofluoric acid (HF) is widely used in industry and at home. Severe lesions can occur after contact with highly concentrated solutions, leading to tissue necrosis and bone destruction. Specific treatment is based on neutralization of fluoride ions with calcium or magnesium solutions. Case report: A 41-year-old male was seen at the emergency department 35 minutes after skin contact with 70% HF, showing whitened swollen lesions on the middle and fourth fingers of his right hand with severe pain starting immediately after contact. 2.5% calcium gluconate ointment was applied. Twenty-four hours later, the patient was still in severe pain and the lesions had worsened. Considering the high concentration of the solution, early start of severe pain, lesion characteristics and impossibility of administering calcium gluconate subcutaneously because of the lesion location, the radial artery was catheterized and 2% calcium gluconate was administered via infusion pump for 36 hours, until the pain subsided. No adverse effects were seen during the procedure. Ten days later, the lesions were stable, without bone abnormalities on X-rays. Six months later, a complete recovery was seen. Conclusions: Intra-arterial calcium gluconate might be considered for finger burns caused by concentrated HF. Complete recovery of wounded fingers can be achieved with this technique even if started 24 hours after the exposure. However, controlled clinical trials are needed to confirm the effectiveness and safety of this intervention.1276379381Anderson, W.J., Anderson, J.R., Hydrofluoric acid burns of the hand: Mechanism of injury and treatment (1988) J Hand Surg Am, 13 (1), pp. 52-57Sheridan, R.L., Ryan, C.M., Quinby Jr., W.C., Blair, J., Tompkins, R.G., Burke, J.F., Emergency management of major hydrofluoric acid exposures (1995) Burns, 21 (1), pp. 62-64Lin, T.M., Tsai, C.C., Lin, S.D., Lai, C.S., Continuous intra-arterial infusion therapy in hydrofluoric acid burns (2000) J Occup Environ Med, 42 (9), pp. 892-897Roblin, I., Urban, M., Flicoteau, D., Martin, C., Pradeau, D., Topical treatment of experimental hydrofluoric acid skin burns by 2.5% calcium gluconate (2006) J Burn Care Res, 27 (6), pp. 889-894Vance, M.V., Curry, S.C., Kunkel, D.B., Ryan, P.J., Ruggeri, S.B., Digital hydrofluoric acid burns: Treatment with intraarterial calcium infusion (1986) Ann Emerg Med, 15 (8), pp. 890-896Graudins, A., Burns, M.J., Aaron, C.K., Regional intravenous infusion of calcium gluconate for hydrofluoric acid burns of the upper extremity (1997) Ann Emerg Med, 30 (5), pp. 604-60

[acute Dapsone Exposure And Methemoglobinemia In Children: Treatment With Multiple Doses Of Activated Charcoal With Or Without The Administration Of Methylene Blue]

OBJECTIVE: To study the changes in methemoglobinemia of 17 children admitted with acute exposure to dapsone complicated by a methemoglobin concentration greater than 20% of the total hemoglobin. The children were treated with multiple doses of activated charcoal with or without the administration of methylene blue.PATIENTS AND METHODS: Seventeen patients (ages 1-13 y, median 3 y), were admitted 1-72 h after the ingestion of 100-1200 mg (median 350 mg, 10 patients) or an unknown amount of dapsone (7 patients). The methemoglobin blood concentrations upon admission ranged from 23.5%-49.7% (median 37.8%), and the main clinical features were cyanosis (17), tachycardia (17), vomiting (11) and tachypnea (8). All of the children received multiple doses of activated charcoal orally or via nasogastric tube (1g/kg, 10% solution, 4-6 times/day, 3-16 doses with a median of 8 doses). Twelve of the 14 patients with methemoglobin levels greater than 30% were also treated with a single dose of methylene blue (1-2% solution, 1-2 mg/kg) infused IV over 5 min.RESULTS: There was a progressive decrease in the methemoglobin levels after the beginning of both treatments (multiple doses of activated charcoal alone or associated with methylene blue), and only one dose of methylene blue was necessary. There were no significant statistical differences between the results of the two treatments according to the time-course decrease in methemoglobinemia (p=0.49 Wilcoxon test).CONCLUSIONS: Multiple doses of activated charcoal given when methemoglobin levels were greater than 20% can be considered as a possible treatment for pediatric patients, with or without the administration of methylene blue, after acute dapsone exposure.76290-