Journal of Medicine and Life Science

  • 제18권1호
  • /
  • Pages.20-23
  • /
  • 2021
  • /
  • 1738-1010(pISSN)
  • /
  • 2671-4922(eISSN)
제주대학교 의과학연구소 (Institute for Medical Science)
권호 표지
DOI QR코드

DOI QR Code

일상적인 음식 섭취 후 발생한 급성 메트헤모글로빈혈증

Acute methemoglobinemia after a normal diet

  • 이성근 (제주대학교 의학전문대학원 응급의학교실) ;
  • 강정호 (제주대학교병원 응급의학과)
  • Lee, Sung Kgun (Department of Emergency Medicine, Jeju National University School of Medicine) ;
  • Kang, Jeong Ho (Department of Emergency Medicine, Jeju National University Hospital)
  • 투고 : 2020.09.19
  • 심사 : 2021.04.08
  • 발행 : 2021.04.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Methemoglobin is generated by the oxidation of ferrous iron to ferric iron within a hemoglobin molecule. Methemoglobin is unable to bind and transport oxygen, resulting in methemoglobinemia, which can lead to fatal tissue hypoxia. The most common cause of methemoglobinemia is poisoning by oxidizing agents such as dapsone, benzocaine, and primaquine. However, methemoglobinemia can also be caused by normal dietary sources. We present two cases of methemoglobinemia that developed after a normal diet in two male patients. In this case report, the patients suddenly developed dyspnea and cyanosis after eating the same meal. They had no history of suspected poisoning, such as the use of drugs, exposure to chemicals, or gas inhalation. Their symptoms did not improve even after a high dose of oxygen was administered; further, an abnormal 'oxygen saturation gap' was observed. Because of CO-oximetry, the methemoglobin levels of the patients were 50.0% and 46.6%, respectively. We administered methylene blue (1 mg/kg), and the patients recovered completely without any complications. Emergency physicians should, therefore, be aware that methemoglobinemia can also be caused by normal dietary sources. In addition, if the source and route of contamination are unclear, an epidemiological investigation should be conducted.

키워드

참고문헌

  1. Lee KW, Lee JB. Antidote for acquired methemoglobinemia: methylene blue. J Korean Med Assoc 2013;56:1084-90. https://doi.org/10.5124/jkma.2013.56.12.1084
  2. You JY. Methylene blue. J Korean Soc Clin Toxicol 2018;8:1-6.
  3. Skold A, Cosco DL, Klein R. Methemoglobinemia: pathogenesis, diagnosis, and management. South Med J 2011;104:757-61. https://doi.org/10.1097/SMJ.0b013e318232139f
  4. Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: etiology, pharmacology, and clinical management. Ann Emerg Med 1999;34:646-56. https://doi.org/10.1016/S0196-0644(99)70167-8
  5. Ash-Bernal R, Wise R, Wright SM. Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals. Medicine (Baltimore) 2004;83:265-73. https://doi.org/10.1097/01.md.0000141096.00377.3f
  6. Sahu KK, Lal A, Mishra A, George S. Food poisoning associated methemoglobinemia: time to wake up. World J Emerg Med 2020;11:127-8. https://doi.org/10.5847/wjem.j.1920-8642.2020.02.013
  7. Chan HTC, Hui AWH, Graham C, Walline J. My mother is looking blue. World J Emerg Med 2019;10:251-2. https://doi.org/10.5847/wjem.j.1920-8642.2019.04.011
  8. Cvetkovic D, Zivkovic V, Lukic V, Nikolic S. Sodium nitrite food poisoning in one family. Forensic Sci Med Pathol 2019;15:102-5. https://doi.org/10.1007/s12024-018-0036-1
  9. Centers for Disease Control and Prevention (CDC). Methemoglobinemia following unintentional ingestion of sodium nitrite--New York, 2002. MMWR Morb Mortal Wkly Rep 2002;51:639-42.
  10. Matteucci O, Diletti G, Prencipe V, Di Giannatale E, Marconi MM, Migliorati G. Two cases of methemoglobinaemia caused by suspected sodium nitrite poisoning. Vet Ital 2008;44:439-53.
  11. Shim JC, Ryu HH, Lee YJ, Kim YS, Youm KI, Moon JM, et al. Relationship between the methemoglobin level and oxygen saturation on a pulse oximeter in cases of acute methemoglobinemia. J Korean Soc Emerg Med 2005;16:588-94.
  12. Sun KH, Kim JK, Ryu CY, Kim SJ, Jo HK, Yoo TH, et al. A case of a herbicide poisoning induced methemoglobinemia patient treated with high-dose vitamin C. J Korean Soc Clin Toxicol 2017;15:148-