Methemoglobinemia

First Things First

• Cyanosis in the face of normal PaO2 is key item.

• Tissue dysoxia and hypoxia cause the deleterious signs/symptoms seen.

• This state causes significant tissue hypoxia, cyanosis and oxidative stress.

• This stressful oxidative state can also lead to hemolysis.

• Supportive treatment
  • High-concentration FiO2 to saturate remaining normal HgG
  • In symptomatic pts, consider methylene blue (see below).
  • Most patients respond within 15-30 minutes.
• Poison control is a good resource for management.