Pediatric Methemoglobinemia Follow-up

  • Author: Michael J Verive, MD; Chief Editor: Max J Coppes, MD, PhD, MBA   more...
 
Updated: Nov 14, 2011
 

Further Inpatient Care

  • Acquired methemoglobinemia: The underlying cause should be identified, and measures should be instituted to avoid further exposure of the patient to precipitating causes.
  • Hereditary methemoglobinemia: Methemoglobin levels and adverse effects of medication should be monitored on an ongoing basis.
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Further Outpatient Care

  • Once the treatment has been instituted for acquired methemoglobinemia, identification and removal of the precipitating cause is all that is necessary, with instruction to avoid future exposure to the precipitating agent (and related agents).
  • If treatment is indicated on an ongoing basis, as in some cases of congenital methemoglobinemia, patients should be observed for effect and toxicity. Both methylene blue and ascorbic acid have been used for this purpose.
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Inpatient & Outpatient Medications

  • See Medication and Further Outpatient Care.
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Transfer

  • The most important step in management is recognition of this entity without subjecting the patient to extensive and invasive studies for cardiopulmonary conditions.
  • Once the diagnosis is established, management should be instituted as indicated.
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Deterrence/Prevention

  • Recognition and avoidance of precipitating factors (such as ingestion of nitrate-contaminated water and exposure to oxidizing medications) are important, especially in susceptible populations.
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Patient Education

  • Patients with both congenital and acquired methemoglobinemia should receive instruction regarding avoidance of precipitating factors.
  • Patients receiving therapy for chronic methemoglobinemia should receive balanced information regarding the risks and benefits expected with treatment.
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Contributor Information and Disclosures
Author

Michael J Verive, MD  Medical Director, Pediatric Intensive Care, Department of Pediatrics, St Mary's Hospital for Women and Children

Michael J Verive, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, Pediatric Sedation, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Mudra Kumar, MD, MBBS, MRCP  Associate Professor, Department of Pediatrics, University of South Florida College of Medicine

Mudra Kumar, MD, MBBS, MRCP is a member of the following medical societies: American Academy of Pediatrics and American Society of Hematology

Disclosure: Nothing to disclose.

Specialty Editor Board

Sharada A Sarnaik, MBBS  Professor of Pediatrics, Wayne State University School of Medicine; Director, Sickle Cell Center, Attending Hematologist/Oncologist, Children's Hospital of Michigan

Sharada A Sarnaik, MBBS is a member of the following medical societies: American Association of Blood Banks, American Association of University Professors, American Society of Hematology, American Society of Pediatric Hematology/Oncology, New York Academy of Sciences, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Steven K Bergstrom, MD  Department of Pediatrics, Division of Hematology-Oncology, Kaiser Permanente Medical Center of Oakland

Steven K Bergstrom, MD is a member of the following medical societies: Alpha Omega Alpha, American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and International Society for Experimental Hematology

Disclosure: Nothing to disclose.

Samuel Gross, MD  Professor Emeritus, Department of Pediatrics, University of Florida; Clinical Professor, Department of Pediatrics, University of North Carolina; Adjunct Professor, Department of Pediatrics, Duke University

Samuel Gross, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA  Senior Vice President, Center for Cancer and Blood Disorders, Children's National Medical Center; Professor of Medicine, Oncology, and Pediatrics, Georgetown University School of Medicine; Clinical Professor of Pediatrics, George Washington University School of Medicine and Health Sciences

Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American Association for Cancer Research, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Mudra Kumar, MD, MBBS, MRCP, to the original writing and development of this article.

References

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Note the chocolate brown color of methemoglobinemia. Tube 1 and tube 2 have a methemoglobin concentration of 70%; tube 3, a concentration of 20%; and tube 4, a normal concentration.
 
 
 
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