Philippe Camus, M.D.

Dijon, France

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The Drug-Induced Respiratory Disease Website

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

Di Fenza R, Shetty NS, Gianni S, Parcha V, Giammatteo V, Safaee Fakhr B, Tornberg D, Wall O, Harbut P, Lai PS, Li JZ, Paganoni S, Cenci S, Mueller AL, Houle TT, Akeju O, Bittner EA, Bose S, Scott LK, Carroll RW, Ichinose F, Hedenstierna M, Arora P, Berra

High-Dose Inhaled Nitric Oxide in Acute Hypoxemic Respiratory Failure due to COVID-19: A Multicenter Phase 2 Trial.

American journal of respiratory and critical care medicine 2023 Sep 29;; — 2023 Sep 29

Syed AU, Jelly AE, Algebaly AA, Altoonisi MM, Shatoory AE

Methemoglobinemia due to nitric oxide therapy in a child after cardiac surgery.

Asian cardiovascular & thoracic annals 2013 Jun;21;345-7 — 2013 Jun — 345-7

Rolley L, Bandeshe H, Boots RJ

'Safe' methaemoglobin concentrations are a mortality risk factor in patients receiving inhaled nitric oxide.

Anaesthesia and intensive care 2011 Sep;39;919-25 — 2011 Sep — 919-25

Sinisterra S, Miravet E, Alfonso I, Soliz A, Papazian O

Methemoglobinemia in an infant receiving nitric oxide after the use of eutectic mixture of local anesthetic.

The Journal of pediatrics 2002 Aug;141;285-6 — 2002 Aug — 285-6

Salguero KL, Cummings JJ

Inhaled nitric oxide and methemoglobin in full-term infants with persistent pulmonary hypertension of the newborn.

Pulmonary pharmacology & therapeutics 2002;15;1-5 — 2002 — 1-5

Weinberger B, Laskin DL, Heck DE, Laskin JD

The toxicology of inhaled nitric oxide.

Toxicological sciences : an official journal of the Society of Toxicology 2001 Jan;59;5-16 — 2001 Jan — 5-16

Hovenga S, Koenders ME, van der Werf TS, Moshage H, Zijlstra JG

Methaemoglobinaemia after inhalation of nitric oxide for treatment of hydrochlorothiazide-induced pulmonary oedema.

Lancet (London, England) 1996 Oct 12;348;1035-6 — 1996 Oct 12 — 1035-6