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Systematic Review of Methemoglobinemia in Acetaminophen Poisoning

Kamal Kant Sahu1, Susan V George1, Ahmad Daniyal Siddiqui2

  • 1Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts, United States.

QJM : Monthly Journal of the Association of Physicians
|May 20, 2020
PubMed
Abstract

Insights

Acetaminophen (APAP) poisoning can rarely cause methemoglobinemia. Early recognition of this uncommon complication is crucial for prompt medical intervention and improved patient outcomes.

Area of Science:

  • Toxicology
  • Emergency Medicine
  • Clinical Pathology

Background:

  • Acetaminophen (APAP) toxicity is a frequent emergency department presentation.
  • Methemoglobinemia is an infrequent but serious complication of APAP overdose.

Purpose of the Study:

  • To review and analyze published cases of acetaminophen-induced methemoglobinemia.
  • To highlight the clinical features, management, and outcomes of this rare condition.

Main Methods:

  • A retrospective analysis of published case reports from 1968 to 2019.
  • Inclusion criteria focused on cases of methemoglobinemia associated with APAP ingestion.

Main Results:

  • 14 cases were identified (9 female, 6 male), with a median age of 59.
  • Altered mentation and cyanosis were common presentations; median methemoglobin level was 15.85%.
  • Treatments included NAC, hemodialysis, methylene blue; 9 patients recovered, 4 died.

Conclusions:

  • Acetaminophen toxicity can present with diverse and severe complications.
  • Methemoglobinemia is a critical, non-classical presentation of APAP toxicity requiring heightened clinical awareness.
Keywords:
AcetaminophenNAPQIascorbic acidmethemoglobinemiamethylene blue

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