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VOLUME 18 , ISSUE 2 ( February, 2014 ) > List of Articles


Acute methemoglobinemia with hemolytic anemia following bio-organic plant nutrient compound exposure: Two case reports

Santoshi Balkrishna Malkarnekar, Raveesha Anjanappa, L. Naveen, B. G. Kiran

Keywords : Bio-organic compound, haemolytic anemia, methemoglobinemia, methylene blue, saturation gap

Citation Information : Malkarnekar SB, Anjanappa R, Naveen L, Kiran BG. Acute methemoglobinemia with hemolytic anemia following bio-organic plant nutrient compound exposure: Two case reports. Indian J Crit Care Med 2014; 18 (2):115-117.

DOI: 10.4103/0972-5229.126089

License: CC BY-ND 3.0

Published Online: 01-12-2014

Copyright Statement:  Copyright © 2014; The Author(s).


Two young women, were reffered to our hospital on two different occasions with history of breathlessness and mental confusion, following consumption of two different bio-organic plant nutrient compounds with a suicidal intent. On examination, they had cyanotic mucous membranes, and their blood samples showed the classic ′dark chocolate brown′ appearance. Work up revealed cyanosis unresponsive to oxygen supplementation and absence of cardiopulmonary abnormality. Pulse oximetry revealed saturation of 75% in case 1 and 80% in case 2, on 8 liters oxygen supplementation via face masks, although their arterial blood gas analysis was normal, suggestive of "saturation gap". Methemoglobinemia was suspected based on these findings and was confirmed by Carbon monoxide-oximetry (CO-oximetry). Methylene blue was administered and the patients showed dramatic improvement. Both the patients developed evidence of hemolysis approximately 72 hours following admission which improved with blood transfusion and supportive treatment. The patients were eventually discharged without any neurological sequalae.

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