Methemoglobinemia in a Child with Glucose-6-phosphate Dehydrogenase Deficiency - A Case Report
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 5, Issue 11
Abstract
Methemoglobin is the reduced form of hemoglobin which is normally found in blood in levels <1%. Methemoglobinemia (MHb) is a disorder which is characterized by methemoglobin levels >1% in blood. Spontaneous formation of methemoglobin is normally counteracted by protective enzyme systems, for example, nicotinamide adenine dinucleotide phosphate methemoglobin reductase. A 2-year-old male child presented with lethargy, oliguria, hemoglobinuria, and icterus. Child had been treated with ofloxacin for urinary tract infection 2 days before presentation. Child had low saturation even with high flow oxygen. Hence, a clinical diagnosis of methemoglobinemia was made. On evaluation, the child was found to have severe hemolysis with low glucose-6-phosphate dehydrogenase (G6PD) activity. Methylene blue, the treatment of choice for MHb, is contraindicated in the presence of G6PD deficiency. Child improved with packed cell transfusion and supplemental oxygen. This case illustrates the potential for severe hemolysis with the use of methylene blue in a case of MHb presenting with G6PD deficiency. Hence, it is advisable to check G6PD activity before administering methylene blue.
Authors and Affiliations
Samyugtha Ragupathi, Arun Priya, Kannan Alagarsamy, Senthil Kumar, Uma Muralidharan
Keywords
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