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- W2513374023 abstract "A 61-year-old male was admitted to the emergency department with the initial presentation of dizziness, and headache after ingestion of 50 mL of indoxacarb in a suicide attempt. His underlying diseases included tongue cancer with local recurrence and hepatitis B infection. On arrival, he remained conscious and his vital signs were as follows: temperature of 37.5°C, pulse rate of 125/minute, respiratory rate of 24/minute and blood pressure of 105/70 mm Hg. The oxygen saturation on pulse oximetry (SpO2) was only 83% on ambient air. Physical examination showed a dusky discoloration of skin with cyanotic nail beds. Further blood tests were arranged and the color of blood was found to be chocolate brown (Figure A). Therefore, a clinical diagnosis of indoxacarb-induced methemoglobinemia was made. Activated charcoal with gastric lavage was administered and supplemental oxygen was given. Laboratory examinations were as follows: white blood cell count of 7,100/mm3, hemoglobin of 9.9 g/dL, platelet of 124,000/mm3, total bilirubin of 0.6 mg/dL and creatinine of 1.13 mg/dL. Measurement of arterial blood gas on nonrebreathing mask with FiO2 of 90% showed pH of 7.43, PaO2 of 340.7 mm Hg, SaO2 of 97.4%, CO2 of 35.0 mm Hg and HCO3− of 24.6 mmol/L, and disclosed a significant saturation gap between SpO2 and SaO2. The level of methemoglobin (MetHb) was found to be 46.8% and confirmed the diagnosis of methemoglobinemia. Thus, methylene blue of 60 mg (1 mg/kg) was intravenously administered. MetHb level decreased to 19.2% after 1 hour and the color of blood became red (Figure B), cyanosis gradually subsided and SpO2 increased to 90%. A second dose of methylene blue (60 mg) was then given and follow-up of MetHb level decreased to 4.2%. Supportive therapy was continued, and the patient was gradually weaned off ventilatory support after 4 days. Under nasal cannula of 3 L/minute, the SpO2 increased to 96-97% and the color of blood became bright red (Figure C). Finally, the patient was discharged uneventfully." @default.
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- W2513374023 date "2017-06-01" @default.
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- W2513374023 title "Methemoglobinemia Caused by Indoxacarb Poisoning" @default.
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- W2513374023 doi "https://doi.org/10.1016/j.amjms.2016.08.004" @default.
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