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Multiorgan Failure Secondary to Intentional Acetaminophen Overdose-Induced Methemoglobinemia
Mohamed A Abutineh1, Chirag Lodha1, George Mitchell2
1Internal Medicine, Edward Via College of Osteopathic Medicine, Spartanburg, USA.
Cureus
|June 11, 2025
Summary
Acetaminophen overdose can cause methemoglobinemia, a condition impairing oxygen transport. Early recognition and treatment with methylene blue are crucial for patients with suspected acetaminophen toxicity and unexplained lactic acidosis.
Area of Science:
- Toxicology
- Emergency Medicine
- Critical Care
Background:
- Acetaminophen toxicity is a common cause of liver injury.
- Methemoglobinemia, a rare complication of acetaminophen overdose, can lead to tissue hypoxia and multiorgan dysfunction.
- Clinical recognition of methemoglobinemia in acetaminophen overdose is often delayed.
Observation:
- A 21-year-old male presented with intentional overdose of acetaminophen, bupropion, and bleach.
- Initial presentation showed no caustic injury but persistent lactic acidosis.
- Elevated methemoglobin levels were detected, indicating impaired oxygenation.
Findings:
- Despite N-acetylcysteine (NAC) treatment, transaminases became abnormal 48 hours post-ingestion.
- Methemoglobinemia was confirmed as the cause of lactic acidosis and tissue ischemia.
- The patient received methylene blue for methemoglobinemia but expired due to multisystem organ failure.
Implications:
- This case highlights the importance of suspecting methemoglobinemia in acetaminophen overdose, even with normal initial liver function tests.
- Prompt diagnosis and treatment of methemoglobinemia are critical to prevent severe outcomes.
- Further research is needed to understand the mechanisms and improve management of acetaminophen-induced methemoglobinemia.
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