Annals of Anesthesiology and Critical Care

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Survival After Methemoglobinemia Associated with Massive Paracetamol Ingestion: A Case Report and Review of the Literature

Liesbeth Geelen 1 , * , Koen Verbeke 2 , Jietse Ryckeboer 1 , Rogier Nieuwendijk 1 and Peter Rogiers 1
Authors Information
1 Department of Intensive Care Medicine, ZNA Middelheim, Antwerp, Belgium
2 Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
Article information
  • Annals of Anesthesiology and Critical Care: 3 (2); e82570
  • Published Online: April 14, 2019
  • Article Type: Case Report
  • Received: July 24, 2018
  • Revised: April 1, 2019
  • Accepted: April 7, 2019
  • DOI: 10.5812/aacc.82570

To Cite: Geelen L, Verbeke K, Ryckeboer J, Nieuwendijk R, Rogiers P. Survival After Methemoglobinemia Associated with Massive Paracetamol Ingestion: A Case Report and Review of the Literature, Ann Anesth Crit Care . Online ahead of Print ; 3(2):e82570. doi: 10.5812/aacc.82570.

Copyright © 2019, Annals of Anesthesiology and Critical Care. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Introduction
2. Case Presentation
3. Discussion
  • 1. Blieden M, Paramore LC, Shah D, Ben-Joseph R. A perspective on the epidemiology of acetaminophen exposure and toxicity in the United States. Expert Rev Clin Pharmacol. 2014;7(3):341-8. doi: 10.1586/17512433.2014.904744. [PubMed: 24678654].
  • 2. Brune K, Renner B, Tiegs G. Acetaminophen/paracetamol: A history of errors, failures and false decisions. Eur J Pain. 2015;19(7):953-65. doi: 10.1002/ejp.621. [PubMed: 25429980].
  • 3. Queiros C, Salvador P, Ventura A, Lopes D. Methemoglobinemia after paracetamol ingestion: A case report. Acta Med Port. 2017;30(10):753-6. doi: 10.20344/amp.8722. [PubMed: 29268071].
  • 4. Kanji HD, Mithani S, Boucher P, Dias VC, Yarema MC. Coma, metabolic acidosis, and methemoglobinemia in a patient with acetaminophen toxicity. J Popul Ther Clin Pharmacol. 2013;20(3):e207-11. [PubMed: 24077426].
  • 5. Kobayashi T, Kawabata M, Tanaka S, Maehara M, Mishima A, Murase T. Methemoglobinemia induced by combined use of sodium nitrate and acetoaminophen. Intern Med. 2000;39(10):860. doi: 10.2169/internalmedicine.39.860. [PubMed: 11030216].
  • 6. MacLean D, Robertson PG, Bain S. Methaemoglobinaemia and paracetamol. Br Med J. 1968;4(5627):390. doi: 10.1136/bmj.4.5627.390-a. [PubMed: 5683591]. [PubMed Central: PMC1912613].
  • 7. Taleb M, Ashraf Z, Valavoor S, Tinkel J. Evaluation and management of acquired methemoglobinemia associated with topical benzocaine use. Am J Cardiovasc Drugs. 2013;13(5):325-30. doi: 10.1007/s40256-013-0027-2. [PubMed: 23696166].
  • 8. Martinez A, Sanchez-Valverde F, Gil F, Clerigue N, Aznal E, Etayo V, et al. Methemoglobinemia induced by vegetable intake in infants in northern Spain. J Pediatr Gastroenterol Nutr. 2013;56(5):573-7. doi: 10.1097/MPG.0b013e3182849d2b. [PubMed: 23287806].
  • 9. Singh R, Vinayagam S, Vajifdar H. Methemoglobinemia as a result of accidental lacquer thinner poisoning. Indian J Crit Care Med. 2012;16(1):44-7. doi: 10.4103/0972-5229.94435. [PubMed: 22557834]. [PubMed Central: PMC3338240].
  • 10. Cortazzo JA, Lichtman AD. Methemoglobinemia: A review and recommendations for management. J Cardiothorac Vasc Anesth. 2014;28(4):1043-7. doi: 10.1053/j.jvca.2013.02.005. [PubMed: 23953868].
  • 11. Skold A, Cosco DL, Klein R. Methemoglobinemia: Pathogenesis, diagnosis, and management. South Med J. 2011;104(11):757-61. doi: 10.1097/SMJ.0b013e318232139f. [PubMed: 22024786].
  • 12. Umbreit J. Methemoglobin--it's not just blue: A concise review. Am J Hematol. 2007;82(2):134-44. doi: 10.1002/ajh.20738. [PubMed: 16986127].
  • 13. Rino PB, Scolnik D, Fustinana A, Mitelpunkt A, Glatstein M. Ascorbic acid for the treatment of methemoglobinemia: The experience of a large tertiary care pediatric hospital. Am J Ther. 2014;21(4):240-3. doi: 10.1097/MJT.0000000000000028. [PubMed: 24914501].
  • 14. Ranasinghe P, Dilrukshi SA, Atukorala I, Katulanda P, Gnanathasan A. Exchange transfusion can be life-saving in severe propanil poisoning: A case report. BMC Res Notes. 2014;7:700. doi: 10.1186/1756-0500-7-700. [PubMed: 25292188]. [PubMed Central: PMC4195897].
  • 15. MacNaughton SM. Acetaminophen toxicosis in a Dalmatian. Can Vet J. 2003;44(2):142-4. doi: 10.1053/j.jvca.2013.02.005. [PubMed: 12650044]. [PubMed Central: PMC340050].
  • 16. Rumbeiha WK, Lin YS, Oehme FW. Comparison of N-acetylcysteine and methylene blue, alone or in combination, for treatment of acetaminophen toxicosis in cats. Am J Vet Res. 1995;56(11):1529-33. [PubMed: 8585668].
  • 17. Schlesinger DP. Methemoglobinemia and anemia in a dog with acetaminophen toxicity. Can Vet J. 1995;36(8):515-7. [PubMed: 7585440]. [PubMed Central: PMC1686995].
  • 18. McConkey SE, Grant DM, Cribb AE. The role of para-aminophenol in acetaminophen-induced methemoglobinemia in dogs and cats. J Vet Pharmacol Ther. 2009;32(6):585-95. doi: 10.1111/j.1365-2885.2009.01080.x. [PubMed: 20444014].
  • 19. Wong A, Graudins A. Risk prediction of hepatotoxicity in paracetamol poisoning. Clin Toxicol (Phila). 2017;55(8):879-92. doi: 10.1080/15563650.2017.1317349. [PubMed: 28447858].

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