A RARE CASE OF IDIOPATHIC METHEMOGLOBINEMIA

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Methemoglobinemia is a condition in which hemoglobin oxidized from the ferrous to ferric state. This alters conformation of interfering with its oxygen carrying capacity. case represents patient idiopathic methemoglobinemia. CASE PRESENTATION: A 59-year-old male no medical history was brought hospital after motor vehicle accident. He restrained driver when he started experiencing blurry vision, shortness breath, palpitations and shivering before losing consciousness. evaluated emergency department; primary secondary survey were unremarkable, resuscitated fluids blood products, otherwise other medications administered. However, continued be hypoxic admitted intensive care unit. Cyanosis noticed his hands feet. Blood gas analysis showed PaO2 289 mmHg (while on O2), subsequent serum methemoglobin 10.9%. treated O2 vitamin C resulting improvement hypoxia normalization levels. Further workup normal G6PD levels negative genetic for any mutations that known cause denied previous cyanosis. DISCUSSION: can congenital or acquired condition. Deficiency cytochrome b5 reductase enzyme, M disease, deficiency enzyme are well causes hereditary Multiple agents have been associated methemoglobinemia including dapsone, topical anesthetics, inhaled nitric oxide. It usually diagnosed level elevated (typically above 5%). detailed along biochemical testing crucial identifying etiology Early recognition condition, determining methemoglobinemia, essential provide appropriate treatment prevent potential complications. Treatment includes providing supportive care, discontinuing offending if identified, administration substances convert back hemoglobin. Interestingly, our reported remote use anesthetic cream contains lidocaine without complications but current use. There reports anesthetics literature, what unique about exposure not typically seen possibility traumatic event had increased oxidative stress body led disruption balance between oxidation reduction reactions CONCLUSIONS: should considered patients cyanosis discordant saturation results. REFERENCE #1: Banimahd, F., Loo, T., Amin, M., Ahadiat, O., Chakravarthy, B., & Lotfipour, S. (2016). rare important clinical presentation induced Western Journal Emergency Medicine, 17(5), 627-629. doi:10.5811/westjem.2016.6.30504 #2: Lipton M, Szlam SM, Barker K, Benitez JG. . Secondary Topical Benzocaine Application Gastrostomy Site. Pediatric Care. 2016;32(5):312–314. doi: 10.1097/PEC.0000000000000800. #3: Falkenhahn, S Kannan, O'Kane, Unexplained acute severe methaemoglobinaemia young adult, British Anaesthesia, Volume 86, Issue 2,2001, Pages 278-280, ISSN 0007-0912, https://doi.org/10.1093/bja/86.2.278. DISCLOSURES: No relevant relationships by Deaa Abu Jazar, source=Web Response Yazan Addasi, Lina Al Qerem, Yaman Alali, Zachary DePew, Kenneth Mueller, Ali Nayfeh,