Home Magazines Editors-in-Chief FAQs Contact Us

Severe methemoglobinemia in a 10-month-old patient in the pediatric intensive care unit. case report


Journal of Anesthesia & Critical Care: Open Access
Caballero-Estupiñán E,<sup>1</sup> López-Álvarez JM,<sup>1,2</sup> Lorenzo-Villegas DL<sup>2</sup>

Abstract

Methemoglobinemia is a condition characterized by elevated levels of methemoglobin (>1.5 g/dl) in the blood, leading to tissue hypoxia and cyanosis. This disorder can range from asymptomatic to severe, with manifestations such as altered mental status and generalized seizures. In children, increased oxidation of hemoglobin’s heme group is ften due to exposure to nitrates found in certain foods and drugs, compounded by infants’ biochemical peculiarities. Prompt recognition and appropriate management are essential to prevent complications. Management involves identifying and eliminating triggers, supportive care, and specific treatments such as methylene blue. However, caution is warranted in patients with glucose-6-phosphate dehydrogenase deficiency, as methylene blue can precipitate hemolysis. Ascorbic acid may be considered as an alternative in such cases. We present a case of a 9-month-old infant admitted to the intensive care unit with severe methemoglobinemia, likely triggered by dietary nitrate exposure. Treatment with methylene blue effectively reduced methemoglobin levels, resolving cyanosis and metabolic acidosis.

Keywords

Methemoglobinemia, cyanosis, methylene blue, pediatrics

Testimonials