Cyanosis without Sulf- or Methemoglobinemia in Patients Receiving Sulfanilamide Treatment.

Cyanosis is very frequently observed in patients receiving sulfanilamide therapy. This cyanosis seems to be almost generally attributed to sulfhemoglobinemia or methemoglobinemia, though few writers have actually identified these derivatives in cyanotic patients. Colebrook and Kenny (1) in an early report, stated that three of thirty-eight patients developed sulfhemoglobinemia, as shown by spectroscopic examination of the blood. Several other papers mention the proved occurrence of sulfhemoglobinemia, especially when sulfanilamide and saline cathartics (such as magnesium sulphate) are given concurrently (2, 3). Marshall and Walzl (4) determined the total hemoglobin from the blood iron in five cyanotic patients, and made simultaneous measurements of the oxygen capacity as an index to the active hemoglobin. Any deficit in oxygen capacity, relative to the total hemoglobin, would indicate inactive forms of hemoglobin such as sulfor methemoglobin. They found only minimal amounts, if any, of such derivatives. Mull and Smith (5) found, in their one case, a discrepancy between the total hemoglobin and the oxygen capacity which they took to mean that the blood was unable to load oxygen normally. They also found a high degree of oxygen unsaturation which they correlated with the abnormal oxygen uptake. The present paper reports observations on eight patients who, in the past year, developed cyanosis with sulfanilamide treatment. The method was the same in principle as that of Marshall and Walzl (4).