Methemoglobinemia: Difference between revisions
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* Ingestion of nitrate compounds, e.g. bismuth nitrate |
* Ingestion of nitrate compounds, e.g. bismuth nitrate |
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== Clinical |
== Clinical Manifestations == |
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* Cyanosis and symptoms of hypoxia |
* Cyanosis and symptoms of hypoxia |
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Latest revision as of 14:55, 15 July 2020
Differential Diagnosis
- Antibiotics
- Dapsone (most common)
- Trimethoprim
- Sulfonamides
- Local anesthetics
- Articaine
- Benzocaine
- Prilocaine
- Aniline dyes
- Metoclopramide
- Rasburicase
- Chlorates
- Bromates
- Ingestion of nitrate compounds, e.g. bismuth nitrate
Clinical Manifestations
- Cyanosis and symptoms of hypoxia
- Hypoxia that does not respond to supplemental oxygen
- Clinical cyanosis in the presence of a normal arterial pO2
Management
- Stop offending agent
- If otherwise well and metHb level < 20%, can monitor
- If unwell or metHb > 30%
- Methylene blue 1-2 mg/kg over 2-5 minutes
- Repeat dose in an hour if metHb still high (e.g. >20%)
- Contraindicated in G6PD deficiency
- May cause serotonin syndrome
- Second-line
- Ascorbic acid
- Exchange transfusion
- Methylene blue 1-2 mg/kg over 2-5 minutes
