Acute methemoglobinemia after a blast injury: a case report

Methemoglobin is a structurally modified form of hemoglobin incapable of binding oxygen, and elevated levels of methemoglobin cause tissue hypoxia. Occupational exposure to 2,4,6-trinitrotoluene, commonly called trinitrotoluene, causes methemoglobinemia. This case report describes a 27-year-old male sergeant who developed methemoglobinemia upon exposure to trinitrotoluene after a blast injury while welding the walls of tank shells. This is the first case of its kind in Korea. The patient had multiple burns in his abdomen and open fractures in his right leg. While his body temperature, heart rate, respiratory rate, arterial blood pressure, and chest X-ray were normal, arterial gas analysis revealed acute (methemoglobinemia concentration, 13.5%; oxygen saturation, 92.0%), probably caused by nitroglycerin exposure. Aspiration and adsorption through the skin and respiratory system were suspected to be the routes of entry. His methemoglobinemia normalized after 4 days after treating the wounds surgically, administering oxygen therapy, and performing blood transfusion.