Severe methemoglobinemia due to insecticide poisoning
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Abstract
Methemoglobinemia is an altered state of hemoglobin resulting in impaired oxygen delivery to the tissues. Deliberate ingestion of certain insecticides and pesticides may result in this condition. We report a case of severe methemoglobinemia after deliberate ingestion of an insecticide marketed to be safe and containing only biological extracts and fillers. Methemoglobinemia should be suspected with low oxygen saturation on pulse oxymetry and the presence of chocolate colored blood. The methemoglobin level of 91% in our patient is the highest level reported among methemoglobinemia survivors.

Case
A 26-year-old lady with no premorbid illnesses allegedly consumed about 20 ml of an insecticide called ‘Kick’ (composition: Biological extracts-2%, Stabilizers-8%, and Fillers and others-90%) with suicidal intent. She was found unresponsive and was taken to a local hospital where she was intubated and mechanically ventilated. She was referred to our hospital after 24 hours of ingestion for further management. At presentation, she was cyanotic with a heart rate of 160/min and blood pressure of 110/70 mm Hg. Saturation measured by pulse oxymetry was 80% on 100% oxygen and her blood was noted to be dark brown in color [Figure 1]. This raised the suspicion of methemoglobinemia and was confirmed by serum MetHb levels of 91% on co-oximetry......

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3943119/?report=reader
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