Abstract
Background
Methemoglobin (MetHb) is an oxidized form of hemoglobin. It is a poor transporter
of oxygen and is unable to deliver oxygen to the tissue. Globally, drug & toxin induced
methemoglobinemia is more common as compared with the congenital form. Methemoglobinemia
caused by paint thinner intoxication is rare. Methylene blue is well established as
the first-line therapy for severe methemoglobinemia.
Case Report
A 25-year old man was brought to the Emergency Department after accidental consumption
of paint thinner. On clinical examination, he had cyanosis and there were discrepancies
in his pulse oximetry and arterial blood gas (ABG) analysis results. With this clue
and supporting laboratory investigations, the diagnosis of toxin-induced methemoglobinemia
was made. Due to the unavailability of methylene blue, alternative treatment with
high-dose vitamin C was attempted, to which the patient responded.
Why Should an Emergency Physician Be Aware of This?
The role of vitamin C in the treatment of methemoglobinemia has not been well established,
with only a few published case reports. This patient had severe methemoglobinemia,
with MetHb of 46.4%, which responded dramatically to vitamin C therapy, with no side
effects. This case shows that high-dose vitamin C is safe and has the potential to
be an effective alternative for the treatment of severe methemoglobinemia. In the
presence of cyanosis, mismatch of pulse-oximetry and ABG-analysis are the key for
the physician to suspect methemoglobinemia.
Keywords
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Article info
Publication history
Published online: December 16, 2017
Accepted:
October 26,
2017
Received in revised form:
October 23,
2017
Received:
August 22,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
