Methemoglobinemia in critically ill patients during extended hemodialysis and simultaneous disinfection of the hospital water supply
IntroductionTo evaluate the cause of methemoglobinemia in patients undergoing extended daily hemodialysis/hemodiafiltration we analyzed the relationship between methemoglobinemia and the water disinfection schedule of the hospital.
Methods: We reviewed all arterial blood gas analyses, obtained over a one-year period, in patients undergoing extended hemodialysis/hemodiafiltration, and compared the methemoglobin concentrations obtained on the days when the water supply was disinfected, using a hydrogen peroxide/silver ion preparation, with data measured on disinfection-free days.
Results: The evaluation of 706 measurements revealed a maximum methemoglobin fraction of 1.0 (0.8; 1.2) % (median and 25th; 75th percentiles) during hemodialysis/hemodiafiltration on the disinfection-free days. The methemoglobin fraction increased to 5.9 (1.3; 8.4) % with a maximal value of 12.2% on the days of water disinfection (p <0.001 compared to disinfection-free days).
Spot checks on hydrogen peroxide concentrations in the water supply, the permeate, and the dialysate, using a semi-quantitative test, demonstrated levels between 10 and 25 mg/l during water disinfection.
Conclusions: Our results demonstrate that even a regular hospital water disinfection technique can be associated with significant methemoglobinemia during extended hemodialysis. Clinicians should be aware of this potential hazard.
Author: Martin BekSven LauleChristine Reichert-JungerRainer HoltkampMichael WiesnerCornelius Keyl
Credits/Source: Critical Care 2009, 13:R162
Published on: 2009-10-12
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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