SHM Converge Scientific Abstract ePoster Gallery-A Potentially Fatal Case of Pork Induced Methemoglobinemia

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This case describes a potentially fatal episode of acquired methemoglobinemia in a 23-year-old man after eating pork leg at a friend’s dinner. About an hour later, he developed tingling in his extremities, severe headache, shortness of breath, confusion, lethargy, and visible cyanosis. In the emergency department, he was hypoxic despite supplemental oxygen, and his blood appeared brown, both classic clues for methemoglobinemia.<br /><br />Methemoglobinemia occurs when ferrous hemoglobin is oxidized to ferric methemoglobin, which cannot carry oxygen effectively, causing tissue hypoxia. Acquired cases are more common than genetic ones and can be triggered by exogenous oxidizing agents, including nitrites used to cure meats. Diagnosis is confirmed by measuring a serum methemoglobin level. A key diagnostic pitfall is that pulse oximetry and calculated oxygen saturation on arterial blood gas can be misleading; oxygen saturation may remain low despite a very high PaO2.<br /><br />In this patient, the ABG showed alkalosis with a PaO2 of 425, and his methemoglobin level was 53%, confirming the diagnosis. Toxicology was consulted, and he was promptly treated with methylene blue and supplemental oxygen. His oxygen saturation improved rapidly, cyanosis resolved, and methemoglobin levels normalized within 24 hours.<br /><br />The case highlights the importance of recognizing methemoglobinemia early, especially when cyanosis and hypoxia do not improve with oxygen. Severe cases, or symptomatic cases with methemoglobin levels above 30%, are medical emergencies. Methylene blue is the treatment of choice and can be life-saving when given promptly.

Asset Subtitle

Bhavin Patel

Meta Tag

Author List Bhavin Patel, Jakub Pach

Category Clinical Vignettes

Concept Methemoglobinemia

Concept Nitrite Exposure

Concept Methylene Blue

Concept Hemoglobin

Concept Tissue Hypoxia

Distinguished Non-Finalist

Presenter Organization University of Massachusetts Chan Medical School

Presenting Author Bhavin Patel

Track Adult

Keywords

methemoglobinemia

acquired methemoglobinemia

cyanosis

methylene blue

nitrite poisoning

brown blood

hypoxia

pulse oximetry

methemoglobin level

toxicology

Methemoglobinemia

Nitrite Exposure

Methylene Blue

Hemoglobin

Tissue Hypoxia