RASBURICASE-INDUCED METHEMOGLOBINEMIA: TREATING NON-CRITICAL LEVELS WITH METHYLENE BLUE IN ANEMIA

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Acquired methemoglobinemia is a life-threatening cause of respiratory failure that occurs when there an increase rate oxidation hemoglobin to methemoglobin resulting in greater affinity for oxygen binding and decreased release the tissues (1). Rasburicase frequently used patients with tumor lysis syndrome. Methemoglobinemia due rasburicase fewer than 1% (2). Usually, glucose-6-phosphate dehydrogenase deficiency are at higher risk developing induced This case report use methylene blue. CASE PRESENTATION: 85-year-old African American female past medical history hypertension CKD stage 3b who was admitted altered mental status, oral intake, ongoing weakness. Her labs were significant hyperuricemia, hypercalcemia, elevated LDH, acute on chronic kidney disease, 14% blasts peripheral smear, normocytic normochromic anemia. She diagnosed AML by bone marrow biopsy. given concern Two days later, patient developed shortness breath hypoxia pulse saturation 70%. Arterial blood gas showed pH 7.429, PaCO2 29.2 mm hg, PaO2 99.9 HCO3 18.9 mmol/L, 16.8%, O2 79.2%. treated therapy determined be causative agent; thus, additional doses not given. The level improved normal over course several days. DISCUSSION: clinical presentation may include gray pigmentation skin, chocolate colored blood, dyspnea neurological symptoms, such as dizziness, headache, seizures. These symptoms vary regards concentrations underlying conditions (3). For example, anemia usually present more severe they have reduced levels suspected based history, hypoxemia refractory supplemental Blood co-oximetry can confirm diagnosis Methylene blue exceed 20-30%; however, if symptomatic (ex. anxiety, light-headedness, or headaches) it should regardless Other treatment options vitamin C red cell exchange transfusion CONCLUSIONS: Diagnosis relies reviewing patient's medication correlating discrepancy arterial gas, resolution offending agent discontinued. Careful evaluation each pertinent considering life-saving treatment, REFERENCE #1: Kaland, D., Borg, M. (2018). Management rasburicase-induced hemolytic JHOP 8(3):132-134. #2: Montgomery KW, Booth GS: A perfect storm: syndrome G6PD deficient adult. (2017) J Clin Apher. 32:62-3. 10.1002/jca.21462 #3: Ludlow JT, Wilkerson RG, Nappe TM. Methemoglobinemia. [Updated 2020 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537317/ DISCLOSURES: No relevant relationships Erica Becker, source=Web Response Soontharee Congrete, Simrina Sabharwal, Jose Soriano,