A bedside test for methemoglobinemia, Sri Lanka.

Area of Science:

• Toxicology
• Clinical Chemistry
• Public Health

Background:

• Propanil herbicide poisoning is a significant cause of mortality, primarily due to methemoglobinemia.
• Effective management is hindered in resource-limited settings by inadequate diagnostic capacity for methemoglobin levels.

Purpose of the Study:

• To evaluate the impact of a novel colorimetric chart for semiquantitative methemoglobin determination on patient outcomes in propanil poisoning.
• To assess the influence of this diagnostic tool on treatment practices and survival rates in rural hospitals.

Main Methods:

• A color reference chart was developed and distributed to three rural hospitals in Sri Lanka.
• Hospital staff received training on using the chart and integrating it with national treatment guidelines.
• Patient data were collected retrospectively before (2003-2007) and after (2008-2014) chart implementation.

Main Results:

• Deaths from propanil poisoning decreased from 10% to 3% following the introduction of the color chart.
• The use of methylene blue, a first-line treatment, increased from 10% to 55% in patients with propanil poisoning.
• The color chart is inexpensive and can be reproduced using standard color printers.

Conclusions:

• The bedside color chart is an effective tool for managing propanil poisoning in resource-limited environments.
• Implementation of the chart led to improved clinical outcomes, including increased survival rates.
• The test's success resulted in its inclusion in national management guidelines for propanil poisoning in 2011.