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Metoclopramide-induced methemoglobinemia
1Department of Pharmaceutics, University of Arkansas for Medical Sciences, Little Rock 72205.
Pediatrics
|September 1, 1988
Summary
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.