Methemoglobinemia in critically ill patients during extended hemodialysis and simultaneous disinfection of the hospital water supply.

Abstract

INTRODUCTION:

To 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.

• Authors: Martin Johannes Bek, Sven Laule, Christine Reichert-Jünger, Rainer Holtkamp, Michael Wiesner, Cornelius Keyl
• Journal: Critical care (London, England) (Crit Care) Vol. 13 Issue 5 Pg. R162 ( 2009) ISSN: 1466-609X [Electronic] England
• PMID: 19821985 (Publication Type: Journal Article)

Chemical References

• Silver Compounds
• Methemoglobin
• Hydrogen Peroxide

Topics

• Aged
• Aged, 80 and over
• Blood Gas Analysis
• Critical Illness
• Disinfection (methods)
• Female
• Hospitals
• Humans
• Hydrogen Peroxide
• Male
• Methemoglobin (analysis, biosynthesis)
• Methemoglobinemia (diagnosis, etiology)
• Middle Aged
• Renal Dialysis
• Retrospective Studies
• Silver Compounds
• Time Factors
• Water Microbiology (standards)
• Water Supply (standards)