A methemoglobin Hb level was also sent, and MetHb resulted at 80.5%.įurther laboratory workup revealed a lactate of 11.8, CMP significant for creatinine of 1.16 mg/dL and otherwise unremarkable, a BAL of 243, and UDS positive for methamphetamines. An arterial blood gas was drawn and revealed a chocolate-colored specimen with the following values: pH 7.36, pCO2 26, pO2 325 (on 100% fiO2), a calculated HCO3- of 12.8, O2 saturation of 95.1%. Her repeat glucose prior to intubation was 164 mg/dl. Labs drawn at this time included a complete blood count (CBC), comprehensive metabolic profile (CMP), serum lactate, blood alcohol level (BAL), troponin, urinalysis (UA), urine drug screen (UDS), serum salicylate and acetaminophen concentrations. The remainder of her physical examination was notable just for a grayish-blue hue to her skin, and her pupil exam was 2mm and sluggishly reactive to light. The patient was immediately intubated secondary to her respiratory compromise, using rapid sequence intubation with 10mg IV etomidate and 30mg IV rocuronium (her weight was estimated at 50kg). Her GCS was recalculated at 6 (eye opening-1, verbal response-1, motor response-3), and she had a positive gag reflex, but significant pooling of secretions near her oral cavity. Repeat vitals at that time revealed a BP of 115/65mmHg, HR of 146bpm, RR of 12, T of 35.7 C, and SpO2 of 88% on RA. The ED staff decided to clinically observe her in the department until she met the criteria for clinical sobriety because she did not have safe transportation home.Īpproximately 65 minutes later, the patient was re-assessed and found to be unresponsive and cyanotic.
The physical exam did not have any overt signs of trauma. Her Glasgow Coma Scale (GCS) on arrival was calculated to be 15 she denied any loss of consciousness or other acute complaints. She was visibly intoxicated, but alert and oriented to person, place and time. Her bedside serum glucose measurement was 125 mg/dl. On initial examination, the patient had a temperature of 36.7 C, heart rate of 88 beats/min, blood pressure of 121/88 mmHg, respiratory rate of 18 breaths/min, and O2 saturation of 96% on room air. The patient was transported on her own volition and was able to ambulate on arrival.
In this case study, a single administration of methylene blue resolved significant amyl nitrate intoxication and critical methemoglobinemia.Ī 26-year-old female with no known medical history presented via EMS to the emergency department at an urban community hospital in Chicago, Illinois, with the chief complaint of intoxication after falling at a local bar and sustaining a possible syncopal event.
0 kommentar(er)
