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LETTER
Year : 2014  |  Volume : 60  |  Issue : 2  |  Page : 213-214

Methemoglobinemia and bedside diagnostic test: Ready for prime time


1 Department of Emergency and Critical Care Medicine, Sri Gokulam Hospitals and Research Institute, Salem, Tamil Nadu, India
2 Department of Neurosciences, Manipal Hospital, Salem, Tamil Nadu, India
3 Department of Anaesthesiology, Chennai Medical College and Research Center, Trichy, Tamil Nadu, India
4 Department of Internal Medicine, Chennai Medical College and Research Center, Trichy, Tamil Nadu, India

Date of Web Publication13-May-2014

Correspondence Address:
Dr. S Senthilkumaran
Department of Emergency and Critical Care Medicine, Sri Gokulam Hospitals and Research Institute, Salem, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.132374

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How to cite this article:
Senthilkumaran S, Balamurugan N, Ananth C, Thirumalaikolundusubramanian P. Methemoglobinemia and bedside diagnostic test: Ready for prime time. J Postgrad Med 2014;60:213-4

How to cite this URL:
Senthilkumaran S, Balamurugan N, Ananth C, Thirumalaikolundusubramanian P. Methemoglobinemia and bedside diagnostic test: Ready for prime time. J Postgrad Med [serial online] 2014 [cited 2019 Aug 23];60:213-4. Available from: http://www.jpgmonline.com/text.asp?2014/60/2/213/132374


Sir,

An interesting report on methemoglobinemia by Wadhawa et al. [1] made us to recall and share rapid bedside techniques which are available to the clinical toxicologists even in resource-limited settings. Acute methemoglobinemia is a common occupational hazard caused due to exposure to a wide range of chemicals such as nitrates, nitrites, and aniline in an industrial area, and often presents as a medical emergency requiring immediate treatment. [2] In rural India, emergency physicians may not have access to sophisticated laboratory equipments (with advanced co-oximeter), which contributes to the high death rates after poisoning. In a time-pressured situation, some bedside investigations may be useful in guiding specific therapy like methylene blue in a cyanosed patient with suspected poisoning. Blood samples with a methemoglobin concentration greater than 20% have an evident chocolate-brown color. A quick and easy bedside test to distinguish deoxyhemoglobin from dyshemoglobin is to bubble 100% oxygen in a tube that contains the dark blood. The blood that remains dark likely does so because of the presence of methemoglobin. Another simple test is to place one to two drops of blood on a white filter paper, and then evaluate for the color change upon exposure to oxygen which is likely to splash potentially infectious blood. The chocolate-brown appearance of methemoglobin does not change with time. In contrast, deoxyhemoglobin appears dark red initially and then brightens after exposure to atmospheric oxygen. [3] Furthermore, the cooking test [4] consists of placing the clotted blood sample in a boiling water bath. After cooking and cooling, the blood sample with methemoglobin will turn pink whereas normal blood will appear dark brown. Ideally, the treatment of methemoglobinemia should be guided by measurements of methemoglobin levels, and the instruments needed to measure methemoglobin are not readily available. Shihana and colleagues [5] had developed a color chart which can facilitate more rapid diagnosis of methemoglobinemia and can estimate the percentage of methemoglobin present in a blood sample taken from a poisoned patient. This is of particular value in settings that lack the analytic instruments capable of performing this task.

From the point of patient safety, methemoglobinemia needs early recognition, diagnosis, and appropriate intervention and/or referral. Also, the circumstances for developing methemoglobinemia have increased in these days. Hence, students of health sciences need to be taught the clinical and diagnostic aspects of methemoglobinemia. They should be trained on these simple bedside diagnostic tests, so that methemoglobinmia may be diagnosed and treated even at the primary care level.

 
 :: References Top

1.Wadhwa J, Kumar RS, Ramasubramanian NS, Hamide A. Methemoglobinemia following ingestion of a weedicide. J Postgrad Med 2013;59:345-6.  Back to cited text no. 1
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2.Dewan A, Patel A, Saiyed H. Acute methemoglobinemia-a common occupational hazard in an industrial city in Western India. J Occup Health 2001;43:168-71.  Back to cited text no. 2
    
3.Henretig FM, Gribetz B, Kearney T, Lacouture P, Lovejoy FH. Interpretation of color change in blood with varying degree of methemoglobinemia. J Toxicol Clin Toxicol 1988;26:293-301.  Back to cited text no. 3
    
4.Seifert SA. Nitrates and nitrites. In: Dart RC, editor. Medical Toxicology. 3 rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. p. 1174-80.  Back to cited text no. 4
    
5.Shihana F, Dissanayake DM, Buckley NA, Dawson AH. A simple quantitative bedside test to determine methemoglobin. Ann Emerg Med 2010;55:184-9.  Back to cited text no. 5
    




 

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2004 - Journal of Postgraduate Medicine
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