A patient undergoing hemodialysis may develop methemoglobinemia if exposed to high levels of chloramines.
Chloramine is formed when chlorine gas or hypochlorite are mixed with ammonia. It is used in municipal water supplies to reduce bacterial contamination.
A dialysis center that used a municipal water supply with chloramines needs to remove it with charcoal filters. Failure to remove the chloramines can cause patients to present with methemoglobinemia.
Clinical findings:
(1) cyanosis
(2) hemolytic anemia with Heinz bodies
(3) normal arterial oxygen concentration
Risk factors:
(1) sudden increase in chloramines concentration
(2) insufficient carbon filtration
(3) portable dialysis unit
Differential diagnosis:
(1) methemoglobinemia from drugs or other sources
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