Methemoglobinemia Secondary to a Traditional Healing Practice Using Mothballs: A Need of Pediatric Vigilance

Acute-onset unexplained hypoxemia persisting despite 100% oxygen has a limited differential diagnosis but poses challenging diagnostic dilemma. Methemoglobinemia, hemolytic condition, may lead to significant complications if it goes undiagnosed during the critical golden hour of an emergency department (ED) presentation. This case report presents clinical details 30-month-old child with acute intravascular hemolysis evident by severe pallor and hemoglobinuria hypoxia documented on pulse oximetry. During ABCDE (Airway, Breathing, Circulation, Disability, Exposure) primary survey, "exposure" revealed parent’s deliberate fastening mothball around waist baby advice traditional healer, which was identified as source naphthalene toxicity. The swift intervention undertaken for hypoxic respiratory compromise just after triage, ball tied cloth removed. Arterial blood gas co-oximetry analysis confirmed methemoglobinemia, other laboratory tests suggested anaemia well favouring hemolysis. With exclusion common differentials anaemia, including sickle cell crisis, autoimmune uremic syndrome, G6PD deficiency, exposure considered culprit both methemoglobinemia. After obtaining history another similar episode six months ago requiring transfusion, we retrospected exposure, parents denied that, saying they were using only last 10 days local healer intent get rid some evil power sickness in their child. analyzing old records prior hospitalization getting assured normal level, intravenous methylene blue administered. But view inadequate response, single volume exchange transfusion performed ED stay only, resulted notable reduction subsequent methemoglobin levels improvement child's condition second day. discharged third day no distress further episodes hemoglobinuria, detailed parental counselling follow-up advice. underscores imperative need timely recognition effective management methemoglobinemia paediatric population while emphasizing potential hazards associated exposure. Further comprehensive investigations are warranted elucidate optimal treatment strategies explore long-term outcomes scenarios.