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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