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Metoclopramide-induced methemoglobinemia
1Department of Pharmaceutics, University of Arkansas for Medical Sciences, Little Rock 72205.
Insights
Metoclopramide overdose in an infant can cause methemoglobinemia, a serious condition leading to cyanosis and respiratory distress. Prompt treatment with methylene blue is effective.
Area of Science:
- Pediatric pharmacology
- Toxicology
- Hematology
Background:
- Gastroesophageal reflux is common in infants.
- Metoclopramide is a medication sometimes used to treat gastroesophageal reflux.
- Iatrogenic overdose can occur with medication administration.
Observation:
- A 3-week-old infant received an iatrogenic overdose of metoclopramide.
- The infant presented with cyanosis, lethargy, irritability, poor feeding, diarrhea, and respiratory distress.
- Laboratory findings revealed significant methemoglobinemia (20.5%) and reduced oxyhemoglobin saturation (79%).
Findings:
- The infant showed a rapid and positive clinical response after a single intravenous dose of methylene blue.
- Post-treatment, methemoglobin reductase activity normalized, and no Hemoglobin M was detected.
- These findings support methylene blue as an effective antidote for metoclopramide-induced methemoglobinemia.
Implications:
- Metoclopramide overdose should be considered in infants presenting with cyanosis, ashen color, lethargy, or motor restlessness.
- Healthcare providers should be vigilant about metoclopramide dosing in infants to prevent iatrogenic overdose.
- Early recognition and treatment of methemoglobinemia are crucial for favorable outcomes in pediatric patients.
Abstract:
The case of a 3-week-old male infant is described. After receiving an iatrogenic overdose of metoclopramide (1.0 mg/kg every six hours) throughout a 36-hour period for the treatment of suspected gastroesophageal reflux, he became cyanotic, lethargic, and irritable, he fed poorly, and he had diarrhea and respiratory distress. Methemoglobinemia (20.5%) and reduced oxyhemoglobin saturation (79%) were identified. The patient had an excellent clinical response following a single IV dose of methylene blue. Subsequently, methemoglobin reductase activity was normal and there was no measurable hemoglobin M. The diagnosis of methemoglobinemia should be considered in any infant receiving large doses of metoclopramide who has clinical findings of cyanosis, ashen color, or a history of lethargy and/or motor restlessness.