A Novel Use of Methylene Blue in the Pediatric ICU

Pediatrics
Chrystal RutledgeLeslie Hayes

Abstract

Methylene blue (MB) is a medication commonly used to treat methemoglobinemia, reducing methemoglobin to hemoglobin. A novel use of MB, as detailed here, is in the treatment of refractory hypotension. A number of reports have detailed use of MB for this purpose in adults, but few data in pediatrics. A 22-month-old girl with Noonan syndrome, biventricular hypertrophic cardiomyopathy, and chronic positive pressure ventilation developed shock with tachycardia, hypotension, and fever after 3 days of diarrhea. She was critically ill, with warm extremities, bounding pulses, and brisk capillary refill. Laboratory tests revealed metabolic acidosis, low mixed venous oxygen saturation, and leukocytosis with bandemia. Treatment of severe septic shock was initiated with fluid resuscitation, inotropic support, sedation, and paralysis. She remained hypotensive despite norepinephrine at 0.7 μg/kg per minute, dopamine at 20 μg/kg per minute, and vasopressin at 0.04 U/kg per hour. Her vasoplegic shock worsened, despite aggressive conventional therapy. Intravenous MB was initiated, with a loading dose of 1 mg/kg followed by a continuous infusion at 0.25 mg/kg per hour. Upon initiation of MB, her systolic blood pressure increased by 33 points (40%...Continue Reading

References

Apr 1, 1982·Annals of Emergency Medicine·S Curry
Dec 1, 1996·The Journal of Pediatrics·W DriscollF C Morin
Oct 1, 1996·Postgraduate Medical Journal·G BrownT Phang
Aug 22, 2000·European Journal of Clinical Pharmacology·C PeterB H Lauterburg
Oct 6, 2001·Critical Care Medicine·M Y KirovL J Bjertnaes
Nov 16, 2002·American Journal of Respiratory and Critical Care Medicine·R Scott WatsonDerek C Angus
Jul 8, 2003·American Journal of Therapeutics·Jack Clifton, Jerrold B Leikin
Feb 5, 2004·The Annals of Thoracic Surgery·Ricardo L LevinFernando J Boullon
Aug 4, 2005·The Journal of Thoracic and Cardiovascular Surgery·Katherine Taylor, Helen Holtby
Jul 25, 2007·Anesthesia and Analgesia·Alexander J C MittnachtDavid L Reich
Aug 25, 2007·Anesthesia and Analgesia·David L McDonaghTerri G Monk
Apr 1, 2008·Indian Journal of Pediatrics·Rajniti PrasadMadhukar Pandey
May 14, 2008·Mini Reviews in Medicinal Chemistry·S Peter StawickiVicente H Gracias
Jan 30, 2010·Nitric Oxide : Biology and Chemistry·Nicole P JuffermansA B Johan Groeneveld
Jun 26, 2010·Pharmacotherapy·Christopher A PaciulloJeremy D Flynn
Jan 20, 2011·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Tristan C DumbartonRobert Green

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Citations

May 27, 2020·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Andrea V Otero LunaRichard W Pierce
Sep 21, 2018·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·Jonathan IlickiTherese Djärv
Jul 22, 2017·Journal of Intensive Care·Tatsuya Kawasaki
Dec 20, 2020·Medical Hypotheses·Giulio Scigliano, Giuseppe Augusto Scigliano
Sep 1, 2021·Pediatric Emergency Care·Renita S Pushparajah Mak, Erica L Liebelt

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