A Case of Severe Methemoglobinemia with Shock and High Saturation Gap Following Suicidal Ingestion of Sodium Nitrite-Saved by Oral Methylene Blue

Abstract

Here we report a case of sodium nitrite ingestion for suicidal attempt, presented in unconsciousness, shock and deeply cyanosed condition. He was pulseless and had no recordable BP with methemoglobin level of 77% and saturation gap of 20. He was put on ventilator in ICU and treated with ionotropes, oral methylene blue and parental ascorbic acid. He completely recovered after two days with normal methemoglobin level. Survival in a case of methemoglobinemia with extremely high level of methemoglobin, non recordable BP and deep cyanosis is rarely reported. We report this case for awareness about the severity of signs and symptoms depend on the methemoglobin concentration in blood, false results of pulse oximetry and high saturation gap in methemoglobinemia, and about the management of the lethal effect of poisoning.