Methemoglobinemia caused by fungicide poisoning: A case report

Authors

  • Mehnaz Ferdous Specialist, General ICU, United Hospital Limited, Dhaka 1212, Bangladesh
  • Amina Sultana Specialist, General ICU, United Hospital Limited, Dhaka 1212, Bangladesh
  • Mohammad Omar Faruq Chief Consultant, General ICU and ED, United Hospital Limited, Dhaka 1212, Bangladesh
  • Umme Kulsum Chy Junior Consultant, General ICU, United Hospital Limited, Dhaka 1212, Bangladesh

DOI:

https://doi.org/10.3329/bccj.v11i1.66047

Keywords:

Methemoglobinemia, saturation gap

Abstract

Methemoglobinemia is a potentially fatal condition at a level of more than 70%. It occurs when the ferrous iron in
Haemoglobin is oxidized to ferric iron, forming methemoglobin (MetHb), causing decreased capability of hemoglobin
to bind and deliver oxygen to tissues. Methemoglobinemia has been linked to a wide array of substances, including
fungicides and industrial chemicals. We describe a patient who developed a high MetHb level of 70.7%, after
deliberately consuming a fungicide, namely Mancozeb. The "oxygen saturation gap" is the difference between the
calculated oxygen saturation from a standard blood gas machine and the reading from a pulse oximeter. If it is greater
than 5%, the patient's hemoglobin may be abnormal, representing carbon monoxide poisoning, methemoglobinemia,
or sulfhemoglobinemia. Disproportionate cyanosis not responding to supplemental oxygen, chocolate brown blood,
and saturation gap of >5% raised the suspicion of methemoglobinemia secondary to ingestion of fungicide. An
alternative approach to treatment including intravenous ascorbic acid, NAC, and multiple blood transfusions was
given due to the unavailability of methylene blue. A high index of suspicion, early recognition, and an alternative
approach to management resulted in a favorable outcome.

Bangladesh Crit Care J March 2023; 11 (1): 46-50

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Published

2023-05-21

How to Cite

Ferdous, M. ., Sultana, A., Faruq, M. O. ., & Chy, U. K. . (2023). Methemoglobinemia caused by fungicide poisoning: A case report. Bangladesh Critical Care Journal, 11(1), 46–50. https://doi.org/10.3329/bccj.v11i1.66047

Issue

Vol. 11 No. 1 (2023)

Section

Case Reports

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