Congenital Methemoglobinemia-Induced Cyanosis in Assault Victim (original) (raw)
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Methemoglobinemia as an uncommon cause of cyanosis
The Netherlands journal of medicine, 1999
Cyanosis is usually caused by decreased arterial oxygen saturation due to pulmonary or cardiac diseases. Methemoglobinemia is a rare cause, sometimes with lethal outcome. Two patients are described, both with an unremarkable cardiopulmonary history, presented with severe cyanosis due to aniline-induced methemoglobinemia that developed at work. The symptoms and the treatment of methemoglobinemia are discussed.
Methemoglobinemia – Two Uncommon Presentations
International Medical Journal Malaysia, 2018
Two rather different cases of methemoglobinemia are presented. The first case is an infant who had a circumcision procedure with prilocaine. The second case involves a 14-year-old girl who attempted suicide with an overdose of metoclopramide and butamirate citrate. The attention is drawn to differences in hospital admission and management especially with respect to methemoglobin level and age. If methemoglobin levels reach ≥ 10%, cyanosis would appear first. Symptoms of hypoxemia and diminished oxygen transport do not develop until levels reach 30 to 40%. Not only early intervention is crucial but also patients should not be discharged from the hospital too soon. Doctors should be able to identify high risk patients, paying a special attention to infants younger than three months old who might be at an increased risk of methemoglobinemia which is a potentially lethal complication of prilocaine. As for our second case, methemoglobin level has not increased, despite an overdose of metoclopramide. This may be due to age or timely elimination of toxic agents by gastric lavage, catharsis and administration of procyclidine.
Acquired Methemoglobinemia- An Overview
2019
Methemoglobinemia is a life-threatening condition that can be congenital or acquired. It is characterized by the inability of haemoglobin to carry oxygen because the ferrous part of the heme molecule has been oxidized to ferric state. Acquired methemoglobinemia is due to medication or chemicals that cause the rate of methemoglobin formation to exceed its rate of reduction. We performed a search of American National library of Medicine (PubMed) with the following key word “Acquired Methemoglobinemia”. Two hundred forty-two episodes (40.1% published in year 2000 or after) were found. A retrospective case series was found. In which it describes the cases of acquired methemoglobinemia detected and the clinical circumstances under which they occurred at two tertiary care hospitals and affiliated outpatient clinics over 28 months. One hundred thirty-eight cases of acquired methemoglobinemia were detected over 28 months. There were no gender predisposition and performed over a wide range o...
Methemoglobinemia treated with hyperbaric oxygen therapy: A case report
Methemoglobinemia is a rare but clinically important condition that should be considered among differential diagnosis' in cyanosis. The conventional treatments of methemoglobinemia are high flow oxygen and methylene blue therapies. We present a 52-year-old male patient who admitted to emergency room with severe cyanosis and dyspnea after he was exposed to paint thinner and zinc phosphate solution. The patient was diagnosed with methemoglobinemia with a MetHb level of 49.1mm/Hg in his arterial blood gas test. Patient's symptoms and increased MetHb levels were resistant to high flow oxygen and methylene blue therapies so hyperbaric oxygen therapy (HBO) as an alternative treatment was initiated and the patient was cured promptly. In this case presentation, we aim to discuss the alternative treatment modalities in methemoglobinemia patients with persistent hypoxia and cyanosis, who are unresponsive to standard methylene blue treatment.
Cureus
Cyanosis and dyspnea are common complaints in adults and have broad differential diagnoses, of which rare ones such as congenital methemoglobinemia should always be considered in the differential diagnosis. Methemoglobinemia might be acquired or congenital. Patients' symptoms vary from severe shortness of breath, mental status changes, and cyanosis to none. The diagnosis of congenital methemoglobinemia is challenging and requires high index of suspension, especially in older patients. In addition, when diagnosed the treatment of congenital methemoglobinemia is oral ascorbic acid which is readily available. We present a rare case of a 33-year-old lady, who had a long history of recurrent episodes of cyanosis, headache, and fatigue. After excluding cardiopulmonary causes, methemoglobin levels were measured and found to be high, and the chart review revealed high levels of methemoglobin in all her previous episodes, without exposure to any offending agent. This raised the concern of a late diagnosis of congenital methemoglobinemia. The patient was treated with a high dose of ascorbic acid resulting in resolution of the symptoms. Congenital methemoglobinemia is a rare diagnosis that needs a high index of suspicion, especially in adults. A thorough history, physical examination, and multiple laboratory tests are needed to confirm the diagnosis and rule out other causes.
Methemoglobinemia in two infants brought to pediatric emergency department
Southern Clinics of Istanbul Eurasia, 2020
Methemoglobinemia is a complication that develops when ferrous hemoglobin is oxidized to a ferric state. It may be congenital due to structural hemoglobin defects or acquired through causes such as exposure to local anesthetic drugs or intake of toxins. Methemoglobinemia is characterized by cyanosis when the blood level exceeds 10%, and at higher levels it may cause tissue hypoxemia, coma, cardiovascular collapse, or even death. The primary mechanism used to reduce the methemoglobin level in the body is the nicotinamide adenine dinucleotide phosphate-cytochrome b5 reductase pathway. This case report is a presentation of the diagnosis and treatment of prilocaine-induced methemoglobinemia in 2 recently circumcised infants admitted to the pediatric emergency department.
A Case Report of Cyanosis With Refractory Hypoxemia: Is It Methemoglobinemia?
Cureus, 2022
Dapsone is used in the treatment of a variety of dermatological conditions and prophylaxis of opportunistic infections. However, if consumed at a dose of more than 200 mg/day, it can cause methemoglobinemia, a condition characterized by elevated methemoglobin levels in the blood; methemoglobin is an abnormal form of hemoglobin, containing iron in the ferric state (Fe 3+) rather than the reduced ferrous form (Fe 2+) found in hemoglobin. A small amount of it is produced in the body due to oxidant damage to the red blood cells. Methemoglobinemia can cause varied clinical manifestations involving the cardio-respiratory and nervous systems depending upon the level of methemoglobin. While it could be congenital, it is commonly caused by exposure to drugs that cause oxidation of hemoglobin, such as benzocaine, dapsone, and nitrates. We report a case of dapsone-induced methemoglobinemia in a previously healthy young female who had consumed 15 tablets of dapsone 100 mg with suicidal intent. She presented with central cyanosis, breathlessness, and altered sensorium after five days of consumption. While the pulse-oximeter showed oxygen saturation (SaO 2) of 84%, arterial blood gas (ABG) analysis showed partial pressure of oxygen (PaO 2) of 427 mmHg and SaO 2 of 98%. This "saturation gap" occurred due to the presence of the abnormal hemoglobin variant. Her cyanosis did not improve despite giving 100% supplemental oxygen. There was no cardiac or respiratory cause to account for her cyanosis. Her methemoglobin level was 45.8%. She was successfully treated with specific antidote methylene blue, mechanical ventilation, and other symptomatic measures. The purpose of this presentation is to help clinicians recognize this condition early, because, if left untreated, it might prove fatal. The diagnostic clues include refractory hypoxemia, central cyanosis in the absence of cardiac and respiratory causes, saturation gap, and chocolate-colored blood.
The Dose Makes the Poison: A Case Report of Acquired Methemoglobinemia
International Journal of Environmental Research and Public Health
Background: Methemoglobinemia (MET) should be suspected in cases where cyanosis is not associated with signs and symptoms of lung and/or heart disease, or in a cyanotic child exhibiting discrepancies in the partial pressure of oxygen in the arterial blood, the blood oxygen saturation, and the clinical assessment. Case presentation: A 10-month-old girl was taken to the Pediatric Emergency Department for the acute, sudden development of significant peroral cyanosis associated with gray pigmentation of the skin. The problem was evidenced approximately one hour after she ingested a homemade puree of mixed vegetables, mainly composed of potatoes and chards that had been prepared three days before and had been kept in the refrigerator since then. Physical examination revealed that the child was very pale, conscious, and without respiratory distress. Oxygen saturation of hemoglobin in the arterial blood (SpO2) was 94%. Respiratory, cardiovascular, and abdominal evaluations did not reveal a...