Die methämoglobinämie bei verbrennungen

Summary

The diagnosis of methaemoglobinaemia after burns is often very difficult because of its lack of clinical symptoms. In a series of 64 patients (including 31 children) with burns of over 15% of the whole body surface, 5 children with a methaemoglobinaemia have been diagnosed and treated. Only in one patient, a four years old girl with 20% of burned body surface, were all clinical symptoms observed, while the methaemoglobin in the blood rose to 57%. The therapy in this case consisted of 1 mg/kg body weight/day of methylene blue and 20 g of Vitamin C intravenously. The grave and dangerous symptoms dissapeared after 5 hours. For the next 20 days the therapy was continued by high dosage of Vitamin C intravenously till the methaemoglobin in the blood became normal.

The other four cases were treated with high dosage of Vitamin C intravenously (4 to 8 g/d) until the Met-Hb concentration in the blood fell to normal level. A hereditary defect of the erythrocytes, which is considered to be the most frequent cause of this disease, has been excluded through laboratory investigations of the various enzymes. Amino-benzol-sulfonamide has been used only in two cases, but the content of sulfonamide in the urine was not increased.

In conclusion, we consider methaemoglobinaemia following burns (especially in children) to be a not very rare complication, and is a reversible toxical consequence of burns caused by the oxydation of haemoglobin.

Therefore we recommend for all cases of burns (over 10 to 15%) a prophylactic therapy of 4 to 5 g/d Vitamin C intravenously.

Zusammenfassung

5 Fälle von Met-Hb-ämie nach Verbrennungen über 15% der gesamten Körperoberfläche werden beschrieben. Es wird auf ein direkte toxische, jedoch reversible Ursache auf Grund der Verbrennungskrankheit hingewiesen und schließlich eine prophylaktische Therapie mit hohen Dosen von Vitamin C täglich empfohlen.