Shades of Blue: A Case Series of Acquired Methemoglobinemia

Abstract

1 Associate consultant, department of critical care medicine, Utkal hospital, Bhubaneswar, Odisha, 2 Consultant, department of oncoanesthesia, Utkal hospital, Bhubaneswar, Odisha, 3 Senior consultant, department of critical care medicine, Utkal hospital, Bhubaneswar, Odisha, 4 Associate consultant, department of critical care medicine, Utkal hospital, Bhubaneswar, Odisha, 5 Consultant, department of critical care medicine, NSH hospital, Nagpur Maharasthra. Abstract Methemoglobinemia is a significant medical condition that can result from oxidative stress in the body. It leads to reduced oxygen delivery to tissues due to altered hemoglobin, which decreases the ability to bind oxygen. As a result, a patient's oxygen saturation on pulse oximetry may be lower, even when supplemental oxygen is provided, while the SaO2 measured through blood gas analysis remains normal. This discrepancy creates a saturation gap. The treatment for methemoglobinemia is methylene blue, which can reverse the condition. We reported a case series of methemoglobinemia due to pesticide exposure. Both patients had low oxygen saturation despite oxygen therapy. On co-oximetry, we confirmed methemoglobinemia. Both patients responded well to methylene blue. Recognisingthat methemoglobinemia can be fatal if not addressed promptly is crucial. Early diagnosis through co-oximetry is essential. By identifying the saturation gap, healthcare providers can initiate early treatment with methylene blue, leading to better patient outcomes.