Health issues - Methemoglobinemia

[Toffle]

I'll post this here, as this topic may have something to do with black and white darkroom chemistry. If there is a better place for this post, the administrators may move it where they please.

Today my wife was diagnosed with Methemoglobinemia, a condition wherein a chemical or environmental trigger prevents the proper bonding of oxygen molecules with blood cells. The pathology for this condition is unsettling, and at times frightening, but not really life-threatening. Among the known triggers for this condition are:
Actaninid - common (So the medical journals say) in darkroom compounds
Aniline dyes
Benzene derivatives
Clofazimine
Chlorates
Chloroquine
Dapsone
Methylene blue
Nitrites - Amyl nitrite, Farryl nitrite, Sodium nitrite, Nitric oxide
Nitrobenzene

Does anyone recognize any of these chemicals as ingredients in common developers, stoppers or fixers? Is anyone familiar with this condition?

It may be possible that my wife's condition is in reaction to some other trigger; in the workplace, perhaps. To simplify the process of elimination, I have, for the time being moved all my chemicals out of the house. I have only been involved in darkroom arts for a few months, and though it is a passion, it is not more important than my wife's health. We have a small house, and the darkroom is in a spare room next to our bedroom. If necessary, I will move my darkroom activities to some other location.

Thanks,

 

[DWThomas]

Hmm - sodium nitrite is found in many (most?) processed meat products -- maybe the problem isn't darkroom related?

DaveT

 

[r-brian]

Methemoglobinemia, also commonly known as Blue Baby Syndrone, is usually caused by ingesting a high concentration of nitrate. The Safe Drinking Water Act sets the drinking water standard at 10 mg/l of nitrate nitrogen.

I am on the technical staff of the NM Environment Dept., Liquid Waste Program (ie septic tanks). One of our main focus is the protection of ground water from nitrate contamination by the excess discharge from septic systems. Nitrate contamination is the most common cause of ground water contamination from septic systems. There have been documented cases nationwide of single wells being impacted by a single septic system, let alone regional impacts caused by a too high of density of septic systems. Hog farms and feed lots are also a good source for nitrate pollution.

The first thing I would do is have your drinking water tested, especially if you are on a private well. Do all your cooking and drinking from bottled water until your water supply is deemed safe. Boiling nitrate water just concentrates the nitrate more so that's why you should not cook with it.

There could be other environmental sources but somehow they have to get into your wife's system. Luckily, by removing the contamination pathway, the nitrate should flush out and the red blood cells should start picking up the oxygen with no problems. Good luck.

Brian

 

[Photo Engineer]

You can get a large quantity of some of those chemicals from new carpeting or inhaling the odor in a new car. It is hard to quantify.

Darkroom chemicals rarely go beyond the darkroom in any case, so unless she had her hands in the solutions, there is little likelyhood of it being from photochemistry.

PE

 

[DrPablo]

I've seen and treated it clinically in AIDS patients who are taking Dapsone. I first think of drug side effects when someone has methemoglobinemia, but I'd certainly call a toxicologist if no responsible medication can be found. There are also genetic causes.

Methomoglobin specifically is when the iron in hemoglobin exists in the ferric (Fe3+) state, whereas it can only bind oxygen in the ferrous (Fe2+) state. Because well over 99% of your total oxygen content is hemoglobin-bound at any given time, this has a similar functional effect as severe anemia, greatly decreasing your oxygen carrying capacity.

Methylene blue is actually the treatment of choice for methemoglobinemia -- it's a strong reducing agent and can donate electrons to the oxidized Fe3+. Ascorbic acid can also be used.

 

[rusty71]

You mention Benzene derivatives. Does she drink citrus flavored soda pop?
Last year it came to light that citric acid and common preservatives like sodium benzoate can form benzene compounds in soft drinks well above the legal safe limits set for drinking water....
To my knowledge only the 7Up company has stopped using sodium benzoate as a preservative.

 

[Toffle]

Thank you all for your replies. Though there is no definitive smoking gun that points to my use of photographic chemicals in our home, it is a prudent first step to remove them from our environment, at least for the time being. The doctor's first question was, "What is different in your home or work environment." What is different is that I set up my first darkroom in March of this year. There may indeed be some other environmental trigger - a co-worker of my wife had a very similar attack yesterday. (before my wife received her diagnosis)

I have read some of the information you have shared here - ironically, Methylene blue can be both a treatment and a trigger and treatment for this condition. The citrus-flavored soda link is news to me... My wife loves her soda.

Again, thank you for your replies. I'm not about to give up on photographic arts; I may simply end up moving my set-up to our garage.

Cheers,

 

[Photo Engineer]

Actaninid is not a word I am familiar with in photographic chemistry. I missed that on first reading. Google comes up blank on it.

Sodium benzoate is a benzene derivative to start with. That is what 'benzoate' means. It is a sodium salt of benzoic acid, a rather benign chemical that is the decomposition product of benzaldehyde, the flavoring in almond oil and cherry syrup.

I have no idea offhand how it would react with citric acid to form something harmful, but it could react with ascorbic acid (vitamin C) to form benzene by reduction, I suppose.

PE

 

[DrPablo]

Tom,

Best of luck with your wife's condition. It is a good idea to consider seeing a hematologist or a geneticist who can evaluate her for the genetic causes of methemoglobinemia -- there are a couple causes, but the best known is cytochrome b5 reductase deficiency.

If this is the case, it may be that for her whole life she's had a low level of methemoglobin, which wouldn't show up on routine blood testing and could have been too mild to cause clinical symptoms. It would be more or less like having mild anemia. But a secondary trigger, perhaps environmental / chemical, could be additive and produce symptoms.

I'd certainly suggest pursuing that before being satisfied if no likely cause can be found. That would also help her avoid other triggers, especially certain drugs, later in life if she has an innate predisposition to it.

 

[jim appleyard]

I can't offer any suggestions, but I wish your wife a speedy recovery.

 

[Toffle]

Actaninid is not a word I am familiar with in photographic chemistry. I missed that on first reading. Google comes up blank on it.

PE

Sorry... gross typo on my part. (reading from two columns of a chart at the same time, I guess) The correct spelling is Acetanilid. In doing my own research, I have found that it was used experimentally in photographic compounds in the 19th century.

Thanks to all for sharing their knowledge and expertise.

 

[fschifano]

Metol, hydroquinone, and phenidone are the most commonly used reducing agents in film developers and all are benzene derivatives. These chemicals are used in very small amounts as developing agents and are always dissolved in water. Short of your wife drinking the stuff, or inhaling the dry powdered chemicals, it seems unlikely that these are causing the problem. Of course, your wife may be extremely sensitive to these chemicals. I am neither a doctor nor a chemist, and can offer no definitive answer.

 

[DrPablo]

Of course, your wife may be extremely sensitive to these chemicals.

I'm not an expert per se in methemoglobinemia, but I don't think you can apply a concept of sensitivity (like we apply to allergic processes, as with metol sensitivity). Methemoglobinemia is not an allergic condition, it's a redox condition.

There can be additive toxicity if she's simultaneously exposed to multiple agents that cause methemoglobinemia, it can be additive with a genetic predisposition, or she was simply had a sufficient exposure to one inciting cause but with no particular sensitivity to it.

Incidentally most people have around 1% methemoglobin when you check an arterial blood gas. If she had a 3% methemoglobin level, that's not too far from normal. I've seen 8% methemoglobin in someone who was asymptomatic.

 

[Toffle]

Well, I have learned a great deal over the last day and a half.

We have, by process of matching known episodes with known triggers, identified dental anesthetics, and quite probably nail polish remover as factors in Dora's condition. There are several other possible triggers we are investigating. We agree that it is most likely not photographic chemicals as I use only liquid agents in my darkroom and she has no direct contact with any of my materials. Still, for the time being, I am willing to err on the side of caution.

I understand that this thread, though of great value to me personally, is probably of less interest to this community as a whole. I don't want to abuse my privileges here. If the administrators wish to close this topic, they may certainly do so. That being said, if anyone has any clear, empirical link between the common darkroom and this condition, I would very much like to know of it.

Thanks again, and have a great weekend, folks.

 

[JBrunner]

Well, I have learned a great deal over the last day and a half.

We have, by process of matching known episodes with known triggers, identified dental anesthetics, and quite probably nail polish remover as factors in Dora's condition. There are several other possible triggers we are investigating. We agree that it is most likely not photographic chemicals as I use only liquid agents in my darkroom and she has no direct contact with any of my materials. Still, for the time being, I am willing to err on the side of caution.

I understand that this thread, though of great value to me personally, is probably of less interest to this community as a whole. I don't want to abuse my privileges here. If the administrators wish to close this topic, they may certainly do so. That being said, if anyone has any clear, empirical link between the common darkroom and this condition, I would very much like to know of it.

Thanks again, and have a great weekend, folks.

I for one find this kind of information very useful, as I had no idea of this condition or its triggers. Though it appears that your darkroom will be exonerated, it still points to proper precaution, understanding, storage, and handling of the chemicals we use.

It has been refreshing that the OP has been met with responsible answers.

Wishing your wife a speedy recovery,


Best

J

 

[MattKing]

Well, I have learned a great deal over the last day and a half.

We have, by process of matching known episodes with known triggers, identified dental anesthetics, and quite probably nail polish remover as factors in Dora's condition. There are several other possible triggers we are investigating. We agree that it is most likely not photographic chemicals as I use only liquid agents in my darkroom and she has no direct contact with any of my materials. Still, for the time being, I am willing to err on the side of caution.

I understand that this thread, though of great value to me personally, is probably of less interest to this community as a whole. I don't want to abuse my privileges here. If the administrators wish to close this topic, they may certainly do so. That being said, if anyone has any clear, empirical link between the common darkroom and this condition, I would very much like to know of it.

Thanks again, and have a great weekend, folks.

Tom:

I'm going out on a limb here, but it seems to me that this thread is as far from an "abuse of privilege" as you can possibly get.

This is a request for help that has informed us all. IMHO, it is the sort of thread that strengthens the forum, and the community it serves.

I join all the previous posters in wishing your wife a fast recovery, and wonderful health thereafter.

Matt

 

[Logan Group]

I agree whole heartedly that not only is this not an "abuse of privilege" but completely appropriate for this form. APUG administrators and members often refer to APUG as a community and as such we should all be concerned with each others welfare. Before you posted to this form you had little idea of what was causing your wife's condition. Who is to say that you would not have identified someone else's ailment with your inquiry? And quite frankly I'm sure you were simply exhausting all options in trying to find a cure for your wife. I should hope someone would do as much for me if I was in your wife's condition.

I appreciate your intent in raising this issue and wish your wife a speedy and complete recovery. Hang in there Tom, were all with you.

 

[DrPablo]

I agree that this is a very appropriate topic. Health issues are always a question when we voluntarily expose ourselves to chemicals, so this is of interest to us even if the association is very unlikely.

It puts me in a tricky position to talk about it, because my thoughts here are merely generic and may or may not have any applicability for your wife (and I'm even taking the diagnosis of methemoglobinemia for granted as well). So I as a physician have to be careful about generic advice when health topics come up (and especially when they're outside my subspecialty), but I'll be happy if I've at least supplemented your understanding to some degree.

 

[resummerfield]

.....This is a request for help that has informed us all. IMHO, it is the sort of thread that strengthens the forum, and the community it serves.

I join all the previous posters in wishing your wife a fast recovery, and wonderful health thereafter......

I agree completely. This is a very important thread.

 

[ic-racer]

First off, I hope your wife recovers uneventfully. Second, I am not shure where you got your list of items in the original post, but from what I recall, Methylene blue is the treatment for severe methemoglobinemia.

 

[Toffle]

First off, I hope your wife recovers uneventfully. Second, I am not shure where you got your list of items in the original post, but from what I recall, Methylene blue is the treatment for severe methemoglobinemia.

Just a couple of quick notes. (to justify resurrecting this ancient thread)

My wife's diagnosis is definitely methemoglobinemia. In the grand scale of things, this is not so bad. For the most part, this is not considered a major illness or disease; it is a condition which can be managed through monitoring chemicals in our environment and diet. Photo chemicals are pretty far down the list of risk factors. (way below nail polish... Hmmmmmmm.......) We are just awaiting the ok from a second specialist before I unpack my darkroom again. (it's ok, I've been doing cyanotypes in the garage lately anyway)

There is some small irony in that Methylene blue, usually the only effective treatment for methemoglobinemia, can sometimes be a trigger for symptoms.

Thanks to all for your notes of concern.

Regards,
Tom, on Point Pelee, Canada

Incidentally, my wife is to date the only documented case of this condition in our region. It's extremely rare.

 

[DrPablo]

Tom, as I'd suggested before, I would very strongly suggest that she be genetically tested for some of the common genetic causes of methemoglobinemia. A hematologist or geneticist could set it up for you. It would help you understand whether or not she is at innate risk of methemoglobinemia, or if this episode was just an unfortunate exposure.

 

[Toffle]

Tom, as I'd suggested before, I would very strongly suggest that she be genetically tested for some of the common genetic causes of methemoglobinemia. A hematologist or geneticist could set it up for you. It would help you understand whether or not she is at innate risk of methemoglobinemia, or if this episode was just an unfortunate exposure.

Thanks, Paul.

The genetic link is definitely being explored. Anecdotal evidence suggests that she has had this condition since childhood. Despite a family full of health care professionals, we had always managed to attribute the symptoms to one thing or another, which is not surprising given the rarity of this condition.

The troublesome thing is that there is no easy way to monitor the level of methemoglobin in the blood. At this point we are learning to be watchful of signs that may indicate that her levels are approaching the symptomatic threshold. In this we are fortunate in that there is a wide range of methemoglobin levels between the point at which symptoms appear and at which there is any real health danger.

Thanks for your support. If there are any interesting developments, I'll post them here. (and I think now I can get my exposed film out of the freezer and get back on track trying to become the next Edward Weston)

Cheers,

 

[DrPablo]

Yeah, the only way to directly monitor methemoglobin is with arterial blood gases. It's an easy procedure to do, but most people won't do it in their office and you basically need immediate access to a lab that can run the test. It also can be pretty painful for the patient. Sometimes you'll see an unexpectedly low oxygen saturation, and that's a clue to the diagnosis of methemoglobinemia (the exact opposite of carbon monoxide poisoning, where you get an inappropriately high oxygen saturation).

At any rate, it sounds like you're in good hands, and best of luck!

 

[Toffle]

Last update. (hopefully)

A little bit of education goes a long way. We've found that very little of our lives has changed in dealing with my wife's condition. The ABG tests are quite a chore, so we are taking care to avoid the obvious triggers and monitoring incidental or secondary signs of an impending episode. To date, we have not had any more trips to the emergency room.

At this point, due to the rarity of this condition in our region, we have not entirely ruled out photo chemicals as a factor. I finally got my darkroom set up in the garage. It's definitely not as convenient as the spare room I was using, but it will work for now. Hopefully by the time the weather turns cold, we will have a much clearer idea of where we stand... (and I can move back in the house)

Thanks once again to all who have expressed interest and concern in our story. (Special thanks to Paul, your knowledge in this area was very reassuring in the early going.)

Regards,