Acute methemoglobinemia with hemolytic anemia foll toxic pla
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Two young women, were reffered to our hospital on two different occasions with history of breathlessness and mental confusion, following consumption of two different bio-organic plant nutrient compounds with a suicidal intent. On examination, they had cyanotic mucous membranes, and their blood samples showed the classic ‘dark chocolate brown’ appearance. Work up revealed cyanosis unresponsive to oxygen supplementation and absence of cardiopulmonary abnormality. Pulse oximetry revealed saturation of 75% in case 1 and 80% in case 2, on 8 liters oxygen supplementation via face masks, although their arterial blood gas analysis was normal, suggestive of “saturation gap”. Methemoglobinemia was suspected based on these findings and was confirmed by Carbon monoxide-oximetry (CO-oximetry). Methylene blue was administered and the patients showed dramatic improvement. Both the patients developed evidence of hemolysis approximately 72 hours following admission which improved with blood transfusion and supportive treatment. The patients were eventually discharged without any neurological sequalae.

A 27-years-old lady presented to our emergency room with complaints of breathlessness and altered sensorium. She had clinical history of alleged consumption of 250ml of bio-organic plant nutrient (growth enhancer) containing 4% of nitrogen-based compound (CORONA), with suicidal intent, 4 hours before arrival to our hospital. She had no notable history of any systemic illness. On examination her mucous membranes were cyanotic. Vital signs at presentation were as follows: Pulse rate, 90 beats/min; respiratory rate, 28 breaths/min; and blood pressure, 100/60 mmHg. Bilateral breath sounds were clear on auscultation and heart sounds were normal. Her arterial blood samples appeared chocolate brown which failed to change colour on exposure to air [Figures ?[Figures11 and ?and2].2]. On 8L/min of supplemental oxygen via face mask, pulse oximetry showed a saturation of 75%, and arterial blood gas analysis showed a partial pressure of O2 of 121 mmHg (80 to 105 mmHg) and a hemoglobin O2 saturation level of 97.8%. Electrocardiogram and chest radiograph were within normal limits......
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