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

Bugelli V, Tarozzi I, Manetti AC, Stefanelli F, Di Paolo M, Chericoni S

Four cases of sodium nitrite suicidal ingestion: A new trend and a relevant Forensic Pathology and Toxicology challenge.

Legal medicine (Tokyo, Japan) 2022 Nov;59;102146 — 2022 Nov — 102146

Saleh D, Lucyk S, McGillis E

Methemoglobinemia caused by sodium nitrite overdose.

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 2022 Aug 08;194;E1066-E1067 — 2022 Aug 08 — E1066-E1067

Yoon JC, Kim SE

Suicide attempt using sodium nitrite ordered on the internet: Two case reports.

Medicine 2022 Jul 15;101;e29355 — 2022 Jul 15 — e29355