Life-Threatening Methaemoglobinaemia Secondary to Cetrimide

Methaemoglobinaemia is a rare but potentially life-threatening condition in which there is diminution of the oxygen-carrying capacity of the circulating haemoglobin. It can result from either congenital or acquired processes. Acquired methaemoglobinaemia is more prevalent than congenital methaemoglobinaemia, and notably it has a higher prevalence in infants and neonates than in adults; it results from exposure to oxidising agents. Methaemoglobin forms when haemoglobin is oxidised to contain iron in the ferric (Fe³⁺) state rather than the normal ferrous (Fe²⁺) state. Methaemoglobinaemia is a clinical diagnosis and is suspected in the presence of hypoxaemia refractory to supplemental oxygen and in the presence of chocolate-coloured blood. Symptoms are usually dependent on the methaemoglobin levels; at levels higher than 35%, systemic symptoms from tissue hypoxia may be fatal. We present a case of severe life-threatening methaemoglobinaemia following intra-abdominal use of cetrimide during hydatid cyst removal in a 60-year-old female.

Cetrimide can cause methaemoglobinaemia when used as a protoscolicidal agent during the surgical treatment of hydatid cysts.Severe methaemoglobinaemia has high mortality rate and is usually missed and not easily diagnosed.