Methylene blue and hyperbaric oxygen treatment in dapson-induced methemoglobinemia

Abstract

Methemoglobinemia is the presence of excessive methemoglobin in the blood. Methemoglobinemia is a rare but clinically important condition that should be considered among the differential diagnoses of cyanosis. It is a fast and relatively easy-to-diagnose procedure. In the treatment of emergency patients; high current O2 (HFO2) is important to ensure saturation of available hemoglobin. Methylene blue is the first-line treatment in asymptomatic patients with symptomatic methemoglobinemia (signs of hypoxia such as chest pain, shortness of breath, or confusion) or with MetHb levels> 20%. A 19-year-old female patient was brought to our emergency department after taking 2.5 grams of dapsone for suicide purposes from another center when the level of methemoglobinemia measured in blood gas was measured as 34%. Hyperbaric oxygen therapy was applied for 90 minutes to the patient who did not respond to high flow oxygen therapy. In this case report, we wanted to describe a patient with hypoxic and cyanotic methemoglobinemia who did not respond to standard methylene blue therapy.

Keywords

• methemoglobinemia
• methylene blue
• cyanosis.