Methemoglobinemia: What the anaesthetist must know

Tandale, Sushama Raghunath; Dave, Nandini; Garasia, Madhu

doi:10.4103/0019-5049.118525

Cited by 5 publications

(2 citation statements)

References 4 publications

(9 reference statements)

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“…Normal MetHb levels are <1%, whereas levels >60% are fatal. 4 We should focus on reducing the exposure and providing…”

Section: Discussionmentioning

confidence: 99%

Indoxacarb Toxicity: Treat the Patient, Not the Monitor

Sharma¹,

Yadav²

2023

Indian Journal of Critical Care Case Report

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The arterial line was secured for hemodynamic monitoring. A short history of recurrent jaundice, easy fatiguability, passing frequent dark urine, and psychiatric medication intake was elicited, which yielded a negative response. This helped us to rule out any associated glucose-6-phosphate dehydrogenase deficiency (G-6-PDD) before initiating the antidote MB. A bolus of 100 mg MB was given intravenously over 10 minutes, following which her SpO 2 levels increased to 98% in 15 minutes. The repeat ABG on room air showed-pH-7.35, PaO 2 -85.3, PaCO 2 -27.7, HCO 3 -015.1, Na/K-0145.5/3.19 MetHb-1.9 %, O 2 Hb-94, and lactate-0.38 (Table 1). Subsequently, MB continued at 50 mg twice daily, and vitamin C was converted to an oral tablet of 500 mg thrice daily. ABG was done twice daily, and lab investigations were repeated in the AICU. Her laboratory value was mostly unremarkable except for the slight rise of creatinine from 0.86 to 0.93. Vitamin C was continued, but MB was stopped on day 3 after a psychiatric evaluation was done. She was shifted to the ward with stable vitals and advised to monitor the kidney function test and urine output.

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“…Normal MetHb levels are <1%, whereas levels >60% are fatal. 4 We should focus on reducing the exposure and providing…”

Section: Discussionmentioning

confidence: 99%

Indoxacarb Toxicity: Treat the Patient, Not the Monitor

Sharma¹,

Yadav²

2023

Indian Journal of Critical Care Case Report

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“…Previously also, general anesthesia has been administered in this patient population without any detrimental outcome. [ 1 4 5 6 ] While contemplating general anesthesia, consideration should be given to avoidance of drugs precipitating methemoglobinemia such as prilocaine, lignocaine, benzocaine, metoclopramide, sodium nitroprusside, isosorbide dinitrate, and nitroglycerin. Meperidine, thiopental, propofol, succinylcholine, and inhalational anesthetics are considered safe and preferred during general anesthesia in these patients.…”

Section: Discussionmentioning

confidence: 99%

Patient with persistent low oxygen saturation for emergency cesarean section

2017

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A 24-year-old woman with previous undiagnosed congenital methemoglobinemia presented for the emergency cesarean section in view of fetal distress. The patient had a persistent low oxygen saturation on pulse oximetry with normal heart rate and blood pressure. Arterial blood gas values were normal. The patient was asymptomatic and respiratory and cardiovascular system examination was normal. The patient underwent cesarean section under general anesthesia and was shifted to the Intensive Care Unit postoperatively. The oxygen saturation was low throughout the intraoperative and postoperative period. A complete evaluation was done postoperatively. Mass spectrophotometry was done, which confirmed methemoglobinemia in the patient.

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Perioperative Hypoxia Secondary to Phenazopyridine-induced Methemoglobinemia in an Adolescent Patient Without Renal Insufficiency or Overdose: An Unusual Case

Shah

Kraft

2019

Urology

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Methemoglobinemia: What the anaesthetist must know

Cited by 5 publications

References 4 publications

Indoxacarb Toxicity: Treat the Patient, Not the Monitor

Indoxacarb Toxicity: Treat the Patient, Not the Monitor

Patient with persistent low oxygen saturation for emergency cesarean section

Perioperative Hypoxia Secondary to Phenazopyridine-induced Methemoglobinemia in an Adolescent Patient Without Renal Insufficiency or Overdose: An Unusual Case

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