Methemoglobinemia treated with hyperbaric oxygen therapy: A case report

Abstract

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.

Multimodal imaging of a patient with poppers maculopathy

“…Methaemoglobinaemia may develop secondary to the use of ‘poppers’ presenting as altered mental state and unexplained low oxygen saturation [ 9 ]. Patients who are unresponsive to standard methylene blue treatment may respond to hyperbaric oxygen therapy [ 10 ]. Our patient received 10 days of hyperbaric oxygen in order to treat hypoxia which may cause photoreceptor damage although he did not have methaemoglobinaemia.…”

Recommendations for diagnosis and treatment of methemoglobinemia

“…83 If there is no improvement with the use of repeated dose of MB, therapeutic whole blood exchange (TWBE) or hyperbaric oxygen therapy should be considered. 84 , 85 , 86 , 87 , 88 In a systematic review, TWBE lead to a survival rate of 81.6% in patients refractory to MB. 89 , 90 …”

Killer hiding under normal oxygen saturation: a case report about methemoglobinemia

“…Low-dose VC was used in this case as an adjuvant antidote because of concerns that high doses of VC causing renal failure related to hyperoxaluria (12). Additionally, when methylene blue is ineffective or contraindications exist, exchange transfusions and hyperbaric oxygen therapy can be considered (7,13). However, there is no clinical research indicating that these treatments are useful.…”