J Korean Soc Clin Toxicol.  2008 Dec;6(2):134-137.

A Patient with Methemoglobinemia after Herbicide Intoxication has Hemolytic Anemia Induced by Methylene Blue

• Kim SP
• Kim DH
• Sun KH
• Yoon DH
• Kim SJ
• Cho SH
• Cho NS

Abstract

Methylene blue is the first choice for treating methemoglobinemia, any increase in normal methemoglobin levels. Methemoglobin is an abnormal hemoglobin in which the iron has been oxidized to the ferric(+3) state, making it incapable of oxygen transport. Methemoglobinemia most commonly results from exposure to oxidizing chemicals, but may also arise form genetic, dietary, or even idiopathic etiologies. Patients with low methemoglobin levels are asymptomatic, but high methemoglobin levels can lead to headaches or even death. Methylene blue, the first-line treatment for methemoglobinemia, can also produce hemolytic anemia. Jaundice or dark urine during methylene blue treatment may indicate hemolytic anemia. A 47-year-old female patient with a history of depressive mood disorder developed significant methemoglobinemia after ingesting a Propanil overdose. Twenty-two hours after ingestion, methemoglobin levels in the blood were 73.2%. She was treated with intravenous methylene blue in the therapeutic range (1 mg/kg every 4 h for 3days). The 2nd day after methylene blue use, methemoglobin levels in the blood were 33%, and the 5th day decreased to 10% with better general condition. The patient had hyperbilirubinemia after hemolytic anemia, but she recovered completely.

Keyword

Methemoglobin; Methylene blue; Hemolytic anemia

MeSH Terms

Anemia, Hemolytic
Eating
Female
Headache
Hemoglobins
Humans
Hyperbilirubinemia
Iron
Jaundice
Methemoglobin
Methemoglobinemia
Methylene Blue
Middle Aged
Mood Disorders
Oxygen
Propanil
Hemoglobins
Iron
Methemoglobin
Methylene Blue
Oxygen
Propanil