A Case of Sodium Chlorite Toxicity Managed with Concurrent Renal Replacement Therapy and Red Cell Exchange

Adam Romanovsky,Dennis Djogovic,Dat Chin

doi:10.1007/s13181-012-0256-9

Abstract

IntroductionSodium chlorite is a powerful oxidizing agent with multiple commercial applications. We report the presentation and management of a single case of human toxicity of sodium chlorite.Case reportA 65-year-old man presented to hospital after accidentally ingesting a small amount of a sodium chlorite solution. His principal manifestations were mild methemoglobinemia, severe oxidative hemolysis, disseminated intravascular coagulation, and anuric acute kidney injury. He was managed with intermittent hemodialysis, followed by continuous venovenous hemofiltration for management of acute kidney injury and in an effort to remove free plasma chlorite. Concurrently, he underwent two red cell exchanges, as well as a plasma exchange, to reduce the burden of red cells affected by chlorite. These interventions resulted in the cessation of hemolysis with stabilization of serum hemoglobin and platelets. The patient survived and subsequently recovered normal renal function.DiscussionThis is only the second case of sodium chlorite intoxication reported in the medical literature and the first to report the use of renal replacement therapy in combination with red cell exchange in its management.

Highlights

Sodium chlorite is a powerful oxidizing agent with multiple commercial applications
We report the only known case of accidental sodium chlorite ingestion leading to mild methemoglobinemia, severe hemolysis, and acute kidney injury (AKI) successfully treated with hemodialysis, followed by hemofiltration and concurrent red cell and plasma exchange
Sodium chlorite is a white crystal that is readily dissolvable in water

Summary

Discussion

Sodium chlorite is a white crystal that is readily dissolvable in water. Its primary commercial application is that of a bleaching agent in the pulp and paper and textile industries. The patient presented with a MetHb level of 59 %, which did not respond to administration of multiple doses of methylene blue He subsequently developed hemolysis and DIC and was treated with continuous arteriovenous hemofiltration. Our patient presented with only mild methemoglobinemia He developed inhibition of G6PD and went on to suffer life-threatening oxidative hemolysis. Methylene blue is ineffective for reducing MetHb. no clinical evidence exists for its use, high-dose N-acetylcysteine may be considered for its theoretical benefit along with minimal risk. No clinical evidence exists for its use, high-dose N-acetylcysteine may be considered for its theoretical benefit along with minimal risk This is the first reported case of sodium chlorite toxicity managed with hemodialysis, hemofiltration, and concurrent red cell and plasma exchange.

Introduction

Findings