Methemoglobinemia is one of my favorite toxicology diagnoses. The diagnosis can often be made at the bedside based on history and physical examination, which is a satisfying bit of detective work. Once the diagnosis is made, patients generally respond promptly to a specific antidote (methylene blue). And this isn't just a parlor trick – diagnosis and therapy can be life-saving.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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Just a single case here, but I recently treated a frequent flyer methemoglobinemic with intravenous vitamin C. The patient has been worked up to the hilt but the cause of her recurring methemoglobinemic “crises” are still unknown. She usually gets treated with methylene blue which works fine to reduce the methemoglobin back to the functional Fe2+ state, but then a day or two after receiving methylene blue she always hemolyzes away the RBC’s the methylene blue was supposed to save so she always has to get pRBC transfusions. I tried 1500mg IV ascorbic acid instead of methylene blue. About 6… Read more »