Friday, January 18, 2019

Treatment of methemoglobinemia

Q: Which of the following vitamins can be used in the treatment of methemoglobinemia (MHb) if Methylene Blue (MB) cannot be used  or not available for any reason?

A) Vitamin A
B) Vitamin B-12
C) Vitamin C
D) Vitamin D 
E) Folic acid (vitamin B-9)


Answer: 

Ascorbic acid (vitamin C) has a reducing potential and can be safely and effectively used at a dose of 1 to 10 grams IV every six hours till recovery from (MHb). Use of even higher doses has been described in the literature.

#toxicology



References:

1. Park SY, Lee KW, Kang TS. High-dose vitamin C management in dapsone-induced methemoglobinemia. Am J Emerg Med 2014; 32:684.e1. 

2. Rehman A, Shehadeh M, Khirfan D, Jones A. Severe acute haemolytic anaemia associated with severe methaemoglobinaemia in a G6PD-deficient man. BMJ Case Rep 2018; 2018. 

3. Rees DC, Kelsey H, Richards JD. Acute haemolysis induced by high dose ascorbic acid in glucose-6-phosphate dehydrogenase deficiency. BMJ 1993; 306:841.

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