Toxic metabolic encephalopathy after parathyroidectomy with methylene blue localization.

OBJECTIVE

To determine the correlation between methylene blue use and toxic metabolic encephalopathy in patients undergoing surgery for primary hyperparathyroidism.

STUDY DESIGN AND

SETTING

A retrospective study of 193 patients was performed to collect demographic, perioperative, and postoperative data. Patients were divided into two groups: Group A (postoperative neurological sequelae) and Group B (no neurological sequelae). All data points were compared between the groups.

RESULTS

Twelve of 193 patients were placed in Group A; 181 patients were placed in Group B. Ten patients in Group A were female, and 10 patients were older than 60 years. Of the patients in Group A, 100% were taking a serotonin reuptake inhibitor (SRI). In Group B, 8.8% of patients were taking an SRI.

CONCLUSION

All the patients who experienced transient neurological events were taking an SRI. A correlation can be made between methylene blue infusion and SRI usage.

SIGNIFICANCE: Patients taking SRIs may represent a high-risk group for postoperative neurological events when methylene blue is utilized.