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Causative Agents in Clinically Significant Methemoglobinemia: A National Poison Data System Study
Brandon K Wills1,2,3, Kirk L Cumpston1,2,3, John W Downs1,2,3
1Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA.
Benzocaine, phenazopyridine, dapsone, and nitrates/nitrites are the most frequent causes of methemoglobinemia requiring methylene blue treatment. Understanding these agents aids therapeutic decisions and diagnosis.
Area of Science:
- Toxicology
- Pharmacology
- Emergency Medicine
Background:
- Methemoglobinemia diagnosis and treatment decisions benefit from identifying common causative agents.
- The National Poison Data System (NPDS) provides valuable data for evaluating these agents.
Purpose of the Study:
- To identify the most frequent etiologic agents associated with clinically significant methemoglobinemia.
- To inform therapeutic strategies and diagnostic approaches for methemoglobinemia.
Main Methods:
- Retrospective cross-sectional chart review of NPDS electronic data (July 1, 2007 - June 30, 2017).
- Inclusion criteria: cases coded for methylene blue treatment; exclusion criteria: substances not causing methemoglobinemia or methylene blue used for refractory shock.
- Analysis focused on substances associated with methylene blue administration for methemoglobinemia.
Main Results:
- 1236 substances were identified after exclusions from 2563 reported substances in 1209 cases.
- The top four substance categories implicated were benzocaine, phenazopyridine, dapsone, and nitrates/nitrites.
- These four categories accounted for over two-thirds of all cases requiring methylene blue.
Conclusions:
- Benzocaine, phenazopyridine, dapsone, and nitrates/nitrites are the primary agents associated with methemoglobinemia treated with methylene blue.
- This study clarifies the relative contributions of various drugs and chemicals in methemoglobinemia cases.
- Findings support targeted diagnostic and therapeutic interventions for methemoglobinemia.
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