Severe methemoglobinemia: Rare presentation of biological extract poisoning

 

Girish Borkar^1*, Neelima Deshpande²

 

Abstract              Background: Methemoglobinemia is an altered conformation of hemoglobin in which ferrous state is oxidised to ferric state.  Biological extracts are rich in nitrogenous products and hence can potentially cause Methemoglobinemia. Methemoglobinemia occurs when hemoglobin is oxidized to form Methemoglobin (MetHb), rendering it incapable of oxygen transport, and if severe, it leads to tissue hypoxia. Methemoglobinemia can arise after exposure to a variety of compounds and exogenous oxidizing agent.  This case report highlights the importance of considering the possibility of methemoglobinemia in case of exposure to biological compounds presenting with cyanosis, dark blood, and hypoxia. Biological Plant Extract called “Kick” was consumed by the patient in this case report. (Composition: Biological extract-2%, Stabilizer-8% and Fillers & Others-90%). Conclusion: Biological Extracts are now a days used by farmers on a increasing scale in India. Morever the availability is easy in market. Overall leading to easy access to the biological extract compound in house which results in their misuse and consumption, accidental or suicidal or homicidal. Early Diagnosis of Methemoglobinemia and early treatment prevent Severe Complications and death in biological plant extract poisoning.

Key Word: Severe methemoglobinemia.

 

INTRODUCTION

Methemoglobinemia occurs when hemoglobin is oxidized to form Methemoglobin (MetHb), rendering it incapable of oxygen transport, and if severe, it leads to tissue hypoxia. Methemoglobinemia can arise after exposure to a variety of compounds and exogenous oxidizing agent. This case report highlights the importance of considering the possibility of methemoglobinemia in case of exposure to biological compounds presenting with cyanosis, dark blood, and hypoxia.

 

CASE PRESENTATION

A 26-years-old Male came to emergency department with history of consumption of about 100ml of an Biological Plant Extract called “Kick” (Composition: Biological extract-2%, Stabilizer-8% and Fillers and Others-90%). Patient consumed the compound 3 hrs back when he was taken to PHC where primary treatment was given and than referred to our Hospital.

 On presentation patient had c/o nausea, vomiting since consumption. Patient had bluish discoloration of lips and finger tips Since 2 hours as observed by relatives. Patient has no other co-morbid conditions. On Examination, patient was cyanotic seen over lips and finger tips. His Heart Rate was 108/min, Blood Pressure-110/70mmHg. SpO₂-80% on Pulse Oxymetry. Systemic Examination was within Normal Limits. Blood was noted to be dark in color on withdrawal for routine investigations.

Treatment

With initial Methemoglobinemia level of 82%, 1mg/kg of Methylene Blue bolus was given and after 3hrs showed a reduction in Methemoglobinemia level to 63%. After 3hrs another bolus dose was administered following which Methemoglobinemia level further decreased to 38%. Methylene Blue infusion was started at 10mg/hr for 24hrs and gradually tapered off over 24hrs. After 48hrs Methemoglobinemia level reduced to 2%.

 

DISCUSSION

Methemoglobinemia should be suspected with pale peripheries, cyanosis, low SPO2 on pulse oximetry and the presence of chocolatd colored blood and hypoxia on ABG Methemoglobinemia is an altered conformation of hemoglobin in which ferrous state is oxidised to ferric state. Bilogical extracts are rich in nitrogenous products and hence can potentially cause Methemoglobinemia

 

CONCLUSION

Early Diagnosis of Methemoglobinemia and early treatment prevent Severe Complications and death in biological plant extract poisoning.

 

REFERENCE

1. Perera M, Shihana F, Kularathne K, Dissanayake D, Dawson A. Acute methaemoglobinaemia after massive nitrobenzene ingestion. BMJ Case Rep 2009. 2009.
2. Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: Etiology, pharmacology and clinical management. Ann Emerg Med. 1999;34:646-56
3. Price D. Goldfrank’s Toxicology Emergencies, 8^th ed. 2006. Methemoglobin inducers; pp. 1734-45.

 

 

 

 

 

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