Recenzija, prikaz
https://doi.org/10.20471/acc.2022.61.s1.16
Methemoglobinemia – a Case Report and Literature Review
Ida Ivek
; Emergency Department, University Hospital Centre Zagreb, Zagreb, Croatia
Tomislav Knotek
; Emergency Department, University Hospital Centre Zagreb, Zagreb, Croatia
Toni Ivičić
; Emergency Department, University Hospital Centre Zagreb, Zagreb, Croatia
Barbara Rubinić
; Emergency Department, University Hospital Centre Zagreb, Zagreb, Croatia
Paola Bajlo
; Emergency Department, University Hospital Centre Zagreb, Zagreb, Croatia
Jasmin Hamzić
; Emergency Department, University Hospital Centre Zagreb, Zagreb, Croatia
Sažetak
The objective of this case report is to present a patient with acquired methemoglobinemia
due to poisoning of an unknown cause. A 55-year-old man was brought to the Emergency
Department, University Hospital Center Zagreb, with an unwell appearance, cyanotic, restless, and
presented with a quantitative consciousness disorder. An initial assessment showed decreased oxygen
saturation (SpO2 85 [%]), while point-of-care arterial blood gas (ABG) analysis assessed normal partial
pressure of oxygen (pO2). Severe lactic acidosis with a compensatory drop in partial pressure of
carbon dioxide (pCO2) and high rates of methemoglobin were found. Supportive oxygen therapy
and crystalloid solutions were administered, which resulted in rapid clinical recovery within 40 minutes
of the initial assessment. Clinical recovery was accompanied by normalized ABG test results taken serially.
Typical antidotes, methylene blue and vitamin C, were not administered due to rapid clinical improvement.
Methemoglobinemia can be congenital (hereditary) or acquired (toxic). Both conditions are
rarely seen in emergency departments, nevertheless, they should be approached properly since methemoglobinemia
can be a severe, and fatal, condition. Methemoglobinemia symptoms are the results of
inadequate oxygen transport. The diagnosis was confirmed by co-oximetry, while three clinical entities
suspected methemoglobinemia: refractory hypoxia, “cyanosis-saturation gap“ and dark brown blood.
This paper reports our patient’s clinical presentation, discusses the causes and mechanisms of possible
poisoning, and reviews recent guidelines for methemoglobinemia management.
Ključne riječi
Lactic acidosis; methemoglobinemia; poisoning
Hrčak ID:
281317
URI
Datum izdavanja:
1.6.2022.
Posjeta: 1.386 *