Philippe Camus, M.D.

Dijon, France

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XXIII.a

Methemoglobinemia

Known since the 1940s (PMID 18883450). Comprehensive list of causal drugs and chemicals available at PMID 1564446. Methemoglobin is the oxidized (Fe3+) species of hemoglobin (Fe2+). Patients present with slate-grey cyanosis, low SpO2, normal SaO2 and PaO2. Normally, methemoglobin is <1%. Levels above 40% can be life-threatening, producing pulmonary edema, cardiovascular collapse (PMID 17122537) CNS disturbances and death. Management includes i.v. methylene blue. A possible rebound increase in MeHb upon treatment requires close monitoring. Excess methylene blue can also produce methemoglobinemia. Guidelines: PMID 34467556.

Publications

Synowiec K, Gawlikowski T, Konopka T, Gajek R, Rojek S

Rare cases of nitrite poisoning by accidental ingestion: Clinical and medico-legal aspects.

Legal medicine (Tokyo, Japan) 2025 Mar;73;102573 — 2025 Mar — 102573

Idries IY, Khristoforov V, Duddala S, Duong YV, Zaman M

Out of the Blue: Methemoglobinemia Associated With the Use of Amyl Nitrite in Rush Poppers for Erectile Stimulation.

Cureus 2023 Jun;15;e41201 — 2023 Jun — e41201

Barrangou-Poueys-Darlas M, Gerardin M, Deheul S, Istvan M, Guerlais M, Fan , Jolliet P, Dejoie T, Victorri-Vigneau C

Poppers Use and High Methaemoglobinaemia: 'Dangerous Liaisons'.

Pharmaceuticals (Basel, Switzerland) 2021 Oct 19;14; — 2021 Oct 19

Tello DM, Doodnauth AV, Patel KH, Gutierrez D, Dubey GR

Poppers-Induced Methemoglobinemia: A Curious Case of the Blues.

Cureus 2021 May 27;13;e15276 — 2021 May 27 — e15276

Nguta JM

Nitrate Poisoning due to Ingestion of Cabbages ( var. L.) (Brassicaceae) in Kitui County, Kenya.

TheScientificWorldJournal 2019;2019;8716518 — 2019 — 8716518

Cvetkovi? D, Živkovi? V, Luki? V, Nikoli? S

Sodium nitrite food poisoning in one family.

Forensic science, medicine, and pathology 2019 03;15;102-105 — 2019 03 — 102-105

Su YF, Lu LH, Hsu TH, Chang SL, Lin RT

Successful treatment of methemoglobinemia in an elderly couple with severe cyanosis: two case reports.

Journal of medical case reports 2012 Sep 11;6;290 — 2012 Sep 11 — 290

Kath MA, Shupp JW, Matt SE, Shaw JD, Johnson LS, Pavlovich AR, Brant JD, Mete M, Jeng JC, Jordan MH

Incidence of methemoglobinemia in patients receiving cerium nitrate and silver sulfadiazine for the treatment of burn wounds: a burn center's experience.

Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society 2011 Mar-Apr;19;201-4 — 2011 Mar-Apr — 201-4

MARCUS H, JOFFE JR

Nitrate methemoglobinemia.

The New England journal of medicine 1949 Apr 14;240;599-602 — 1949 Apr 14 — 599-602

Attof R, Magnin C, Bertin-Maghit M, Olivier L, Tissot S, Petit P

Methemoglobinemia by cerium nitrate poisoning.

Burns : journal of the International Society for Burn Injuries 2006 Dec;32;1060-1 — 2006 Dec — 1060-1

Methemoglobinemia following unintentional ingestion of sodium nitrite--New York, 2002.

MMWR. Morbidity and mortality weekly report 2002 Jul 26;51;639-42 — 2002 Jul 26 — 639-42

Saito T, Takeichi S, Osawa M, Yukawa N, Huang XL

A case of fatal methemoglobinemia of unknown origin but presumably due to ingestion of nitrate.

International journal of legal medicine 2000;113;164-7 — 2000 — 164-7

Keating JP, Lell ME, Strauss AW, Zarkowsky H, Smith GE

Infantile methemoglobinemia caused by carrot juice.

The New England journal of medicine 1973 Apr 19;288;824-6 — 1973 Apr 19 — 824-6