Methemoglobinemia Questions & Answers

1. Ludlow JT, Wilkerson RG, Nappe TM. Methemoglobinemia. 2023 Jan. [QxMD MEDLINE Link]. [Full Text].

2. Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: etiology, pharmacology, and clinical management. Ann Emerg Med. 1999 Nov. 34(5):646-56. [QxMD MEDLINE Link].

3. McQueen CA, ed. Comprehensive Toxicology. 3rd ed. Amsterdam, Netherlands: Elsevier; 2017. Vol 12:

4. Curry S. Methemoglobinemia. In: Rosen P, Barkin R, Danzl DF, et al, eds. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St Louis, Mo: Mosby-Year Book; 1997.

5. Benz EJ Jr, Ebert BL. Hemoglobin Variants Associated With Hemolytic Anemia, Altered Oxygen Affinity, and Methemoglobinemias. In: Hoffman R, Benz EJ Jr, Slberstein LE, Heslop H, Weitz J, Anastasi J, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier/Saunders; 2012. 573-80.

6. do Nascimento TS, Pereira RO, de Mello HL, Costa J. Methemoglobinemia: from diagnosis to treatment. Rev Bras Anestesiol. 2008 Nov-Dec. 58(6):657-64, 651-7. [QxMD MEDLINE Link]. [Full Text].

7. Percy MJ, McFerran NV, Lappin TR. Disorders of oxidised haemoglobin. Blood Rev. 2005 Mar. 19(2):61-8. [QxMD MEDLINE Link].

8. Mansouri A, Lurie AA. Concise review: methemoglobinemia. Am J Hematol. 1993 Jan. 42(1):7-12. [QxMD MEDLINE Link].

9. Curry S. Methemoglobinemia. Ann Emerg Med. 1982 Apr. 11(4):214-21. [QxMD MEDLINE Link].

10. Goluboff N, Wheaton R. Methylene blue induced cyanosis and acute hemolytic anemia complicating the treatment of methemoglobinemia. J Pediatr. 1961 Jan. 58:86-9. [QxMD MEDLINE Link].

11. Gebara BM, Goetting MG. Life-threatening methemoglobinemia in infants with diarrhea and acidosis. Clin Pediatr (Phila). 1994 Jun. 33(6):370-3. [QxMD MEDLINE Link].

12. Bento C, Magalhães Maia T, Carvalhais I, Moita F, Abreu G, Relvas L, et al. Transient neonatal cyanosis associated with a new Hb F variant: Hb F Viseu. J Pediatr Hematol Oncol. 2013 Mar. 35(2):e77-80. [QxMD MEDLINE Link].

13. Allen A, Fisher C, Premawardhena A, Bandara D, Perera A, Allen S. Methemoglobinemia and ascorbate deficiency in hemoglobin E ß thalassemia: metabolic and clinical implications. Blood. 2012 Oct 11. 120(15):2939-44. [QxMD MEDLINE Link].

14. Ward KE, McCarthy MW. Dapsone-induced methemoglobinemia. Ann Pharmacother. 1998 May. 32(5):549-53. [QxMD MEDLINE Link].

15. Grauer SE, Giraud GD. Toxic methemoglobinemia after topical anesthesia for transesophageal echocardiography. J Am Soc Echocardiogr. 1996 Nov-Dec. 9(6):874-6. [QxMD MEDLINE Link].

16. Ash-Bernal R, Wise R, Wright SM. Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals. Medicine (Baltimore). 2004 Sep. 83(5):265-73. [QxMD MEDLINE Link].

17. Ohashi K, Yukioka H, Hayashi M, Asada A. Elevated methemoglobin in patients with sepsis. Acta Anaesthesiol Scand. 1998 Jul. 42(6):713-6. [QxMD MEDLINE Link].

18. Forestier A, Pissard S, Cretet J, Mambie A, Pascal L, Cliquennois M, et al. Congenital Recessive Methemoglobinemia Revealed in Adulthood: Description of a New Mutation in Cytochrome b5 Reductase Gene. Hemoglobin. 2015 Jul 31. 1-4. [QxMD MEDLINE Link].

19. Wills BK, Cumpston KL, Downs JW, Rose SR. Causative Agents in Clinically Significant Methemoglobinemia: A National Poison Data System Study. Am J Ther. 2020 Dec 29. 28 (5):e548-e551. [QxMD MEDLINE Link].

20. Fuller TD, Spracklen CN, Ryckman KK, Knake LA, Busch TD, Momany AM, et al. Genetic variation in CYB5R3 is associated with methemoglobin levels in preterm infants receiving nitric oxide therapy. Pediatr Res. 2015 Mar. 77 (3):472-6. [QxMD MEDLINE Link].

21. Fan AM, Steinberg VE. Health implications of nitrate and nitrite in drinking water: an update on methemoglobinemia occurrence and reproductive and developmental toxicity. Regul Toxicol Pharmacol. 1996 Feb. 23(1 pt 1):35-43. [QxMD MEDLINE Link].

22. Erkekoglu P, Baydar T. Evaluation of nitrite contamination in baby foods and infant formulas marketed in Turkey. Int J Food Sci Nutr. 2009 May. 60(3):206-9. [QxMD MEDLINE Link].

23. [Guideline] Greer FR, Shannon M. Infant methemoglobinemia: the role of dietary nitrate in food and water. Pediatrics. 2005 Sep. 116(3):784-6. [QxMD MEDLINE Link].

24. Padovano M, Aromatario M, D'Errico S, Concato M, Manetti F, David MC, et al. Sodium Nitrite Intoxication and Death: Summarizing Evidence to Facilitate Diagnosis. Int J Environ Res Public Health. 2022 Oct 27. 19 (21):[QxMD MEDLINE Link]. [Full Text].

25. Andelhofs D, Van Den Bogaert W, Lepla B, Croes K, Van de Voorde W. Suicidal sodium nitrite intoxication: a case report focusing on the postmortem findings and toxicological analyses-review of the literature. Forensic Sci Med Pathol. 2023 Jun 23. [QxMD MEDLINE Link].

26. McNulty R, Kuchi N, Xu E, Gunja N. Food-induced methemoglobinemia: A systematic review. J Food Sci. 2022 Apr. 87 (4):1423-1448. [QxMD MEDLINE Link].

27. Odièvre MH, Danékova N, Mesples B, Chemouny M, Couque N, Parez N, et al. Unsuspected glucose-6-phosphate dehydrogenase deficiency presenting as symptomatic methemoglobinemia with severe hemolysis after fava bean ingestion in a 6-year-old boy. Int J Hematol. 2011 May. 93(5):664-6. [QxMD MEDLINE Link].

28. Beretta A, Manuelli M, Cena H. Favism: Clinical Features at Different Ages. Nutrients. 2023 Jan 10. 15 (2):[QxMD MEDLINE Link]. [Full Text].

29. Medarov BI, Pahwa S, Reed S, Blinkhorn R, Rane N, Judson MA. Methemoglobinemia Caused by Portable Dialysis in the Critically Ill. Crit Care Med. 2017 Feb. 45 (2):e232-e235. [QxMD MEDLINE Link].

30. Moore TJ, Walsh CS, Cohen MR. Reported adverse event cases of methemoglobinemia associated with benzocaine products. Arch Intern Med. 2004 Jun 14. 164(11):1192-6. [QxMD MEDLINE Link].

31. Bohnhorst B, Hartmann H, Lange M. Severe methemoglobinemia caused by continuous lidocaine infusion in a term neonate. Eur J Paediatr Neurol. 2017 May. 21 (3):576-579. [QxMD MEDLINE Link].

32. Guay J. Methemoglobinemia related to local anesthetics: a summary of 242 episodes. Anesth Analg. 2009 Mar. 108(3):837-45. [QxMD MEDLINE Link].

33. So TY, Farrington E. Topical Benzocaine-induced Methemoglobinemia in the Pediatric Population. J Pediatr Health Care. 2008 Nov-Dec. 22(6):335-9. [QxMD MEDLINE Link].

34. Kath MA, Shupp JW, Matt SE, Shaw JD, Johnson LS, Pavlovich AR. Incidence of methemoglobinemia in patients receiving cerium nitrate and silver sulfadiazine for the treatment of burn wounds: a burn center's experience. Wound Repair Regen. 2011 Mar-Apr. 19(2):201-4. [QxMD MEDLINE Link].

35. Chowdhury D. A young lady presenting to the emergency department with blue lips: A case study with review of literature. World J Emerg Med. 2020. 11 (2):122-124. [QxMD MEDLINE Link]. [Full Text].

36. Chowdhary S, Bukoye B, Bhansali AM, Carbo AR, Adra M, Barnett S, et al. Risk of topical anesthetic-induced methemoglobinemia: a 10-year retrospective case-control study. JAMA Intern Med. 2013 May 13. 173(9):771-6. [QxMD MEDLINE Link].

37. Watton C, Smith K, Carter E. Methemoglobinemia as a complication of topical dapsone. N Engl J Med. 2015 Jan 29. 372 (5):492. [QxMD MEDLINE Link]. [Full Text].

38. Skold A, Klein R. Symptomatic-Low Grade Methemoglobinemia Because of Dapsone: A Multiple Hit Hypothesis. Am J Ther. 2011 Jun 3. [QxMD MEDLINE Link].

39. Góth L, Bigler NW. Catalase deficiency may complicate urate oxidase (rasburicase) therapy. Free Radic Res. 2007 Sep. 41 (9):953-5. [QxMD MEDLINE Link].

40. Ibrahim U, Saqib A, Mohammad F, Atallah JP, Odaimi M. Rasburicase-induced methemoglobinemia: The eyes do not see what the mind does not know. J Oncol Pharm Pract. 2017 Jan 1. 41(9):1078155217701295. [QxMD MEDLINE Link].

41. Vidhyashree BH, Zuber M, Taj S, Venkataraman R, Sathish Kumar BP, Jabeen N. Rasburicase induced methemoglobinemia: A systematic review of descriptive studies. J Oncol Pharm Pract. 2022 Jul. 28 (5):1189-1206. [QxMD MEDLINE Link].

42. Geetha A, Lakshmi Priya MD, Jeyachristy SA, Surendran R. Level of oxidative stress in the red blood cells of patients with liver cirrhosis. Indian J Med Res. 2007 Sep. 126(3):204-10. [QxMD MEDLINE Link]. [Full Text].

43. Olsen TA, Martini DJ, Evans ST, Goldman JM, Bilen MA. Symptomatic methemoglobinemia in a patient with metastatic clear cell renal cell carcinoma treated with pembrolizumab and axitinib combination therapy: a case report. J Med Case Rep. 2021 Feb 19. 15 (1):72. [QxMD MEDLINE Link].

44. Romanovsky A, Djogovic D, Chin D. A case of sodium chlorite toxicity managed with concurrent renal replacement therapy and red cell exchange. J Med Toxicol. 2013 Mar. 9(1):67-70. [QxMD MEDLINE Link].

45. Warriner DR, Morris P, Ramjiani V, Morton A, Sheridan P. Smells like a heart attack, but is it?. BMJ Case Rep. 2011. 2011:[QxMD MEDLINE Link].

46. Grundlingh J, Dargan PI, El-Zanfaly M, Wood DM. 2,4-dinitrophenol (DNP): a weight loss agent with significant acute toxicity and risk of death. J Med Toxicol. 2011 Sep. 7(3):205-12. [QxMD MEDLINE Link].

47. Severe methemoglobinemia and hemolytic anemia from aniline purchased as 2C-E (4-ethyl-2,5-dimethoxyphenethylamine), a recreational drug, on the Internet - Oregon, 2011. MMWR Morb Mortal Wkly Rep. 2012 Feb 10. 61(5):85-8. [QxMD MEDLINE Link].

48. Weichert I. Acute management of cocaine-associated methaemoglobinaemia. Case Rep Med. 2011. 2011:136396. [QxMD MEDLINE Link].

49. Hunter L, Gordge L, Dargan PI, Wood DM. Methaemoglobinaemia associated with the use of cocaine and volatile nitrites as recreational drugs: a review. Br J Clin Pharmacol. 2011 Jul. 72(1):18-26. [QxMD MEDLINE Link].

50. Vieira JL, Ferreira MES, Ferreira MVD, Gomes MM. Primaquine in Plasma and Methemoglobinemia in Patients with Malaria Due to Plasmodium vivax in the Brazilian Amazon Basin. Am J Trop Med Hyg. 2017 May. 96 (5):1171-1175. [QxMD MEDLINE Link].

51. Carmona-Fonseca J, Alvarez G, Maestre A. Methemoglobinemia and adverse events in Plasmodium vivax malaria patients associated with high doses of primaquine treatment. Am J Trop Med Hyg. 2009 Feb. 80(2):188-93. [QxMD MEDLINE Link].

52. Loiseau PM, Cojean S, Schrével J. Sitamaquine as a putative antileishmanial drug candidate: from the mechanism of action to the risk of drug resistance. Parasite. 2011 May. 18(2):115-9. [QxMD MEDLINE Link].

53. Rianprakaisang T, Blumenberg A, Hendrickson RG. Methemoglobinemia associated with massive acetaminophen ingestion: a case series. Clin Toxicol (Phila). 2020 Jun. 58 (6):495-497. [QxMD MEDLINE Link].

54. Fung HT, Lai CH, Wong OF, Lam KK, Kam CW. Two cases of methemoglobinemia following zopiclone ingestion. Clin Toxicol (Phila). 2008 Feb. 46(2):167-70. [QxMD MEDLINE Link].

55. Park JS, Kim H, Lee SW, Min JH. Successful treatment of methemoglobinemia and acute renal failure after indoxacarb poisoning. Clin Toxicol (Phila). 2011 Oct. 49(8):744-6. [QxMD MEDLINE Link].

56. Mostafazadeh B, Pajoumand A, Farzaneh E, Aghabiklooei A, Rasouli MR. Blood levels of methemoglobin in patients with aluminum phosphide poisoning and its correlation with patient's outcome. J Med Toxicol. 2011 Mar. 7(1):40-3. [QxMD MEDLINE Link].

57. Rosen PJ, Johnson C, McGehee WG, Beutler E. Failure of methylene blue treatment in toxic methemoglobinemia. Association with glucose-6-phosphate dehydrogenase deficiency. Ann Intern Med. 1971 Jul. 75(1):83-6. [QxMD MEDLINE Link].

58. Grossmann J, Neuwald S, Wiese B. [Acute respiratory failure after metoclopramide for methemoglobinemia - a rare and potentially life-threatening side effect]. Z Gastroenterol. 2012 Jun. 50(6):585-8. [QxMD MEDLINE Link].

59. Sahu KK, Mishra AK, Mishra K. Methemoglobinemia in COVID-19. Am J Med Sci. 2021 Aug. 362 (2):222-224. [QxMD MEDLINE Link].

60. Lopes DV, Lazar Neto F, Marques LC, Lima RBO, Brandão AAGS. Methemoglobinemia and hemolytic anemia after COVID-19 infection without identifiable eliciting drug: A case-report. IDCases. 2021. 23:e01013. [QxMD MEDLINE Link].

61. Palmer K, Dick J, French W, Floro L, Ford M. Methemoglobinemia in Patient with G6PD Deficiency and SARS-CoV-2 Infection. Emerg Infect Dis. 2020 Sep. 26 (9):[QxMD MEDLINE Link].

62. Malakah MA, Baghlaf BA, Alsulami SE. Co-Occurring Hemolysis and Methemoglobinemia After COVID-19 Infection in Patient With G6PD Deficiency. Cureus. 2023 Feb. 15 (2):e35020. [QxMD MEDLINE Link]. [Full Text].

63. Vallurupalli S, Das S, Manchanda S. Infection and the Risk of Topical Anesthetic Induced Clinically Significant Methemoglobinemia after Transesophageal Echocardiography. Echocardiography. 2009 Aug 31. [QxMD MEDLINE Link].

64. Jiminez MA, Polena S, Coplan NL, Patel K, Gintautas J. Methemoglobinemia and transesophageal echo. Proc West Pharmacol Soc. 2007. 50:134-5. [QxMD MEDLINE Link].

65. Esbenshade AJ, Ho RH, Shintani A, Zhao Z, Smith LA, Friedman DL. Dapsone-induced methemoglobinemia: a dose-related occurrence?. Cancer. 2011 Aug 1. 117(15):3485-92. [QxMD MEDLINE Link].

66. Rechetzki KF, Henneberg R, da Silva PH, do Nascimento AJ. Reference values for methemoglobin concentrations in children. Rev Bras Hematol Hemoter. 2012. 34(1):14-6. [QxMD MEDLINE Link]. [Full Text].

67. Yano SS, Danish EH, Hsia YE. Transient methemoglobinemia with acidosis in infants. J Pediatr. 1982 Mar. 100(3):415-8. [QxMD MEDLINE Link].

68. Chaurasia S, Ramappa M, Bhargava A. Corneal epitheliopathy in congenital methemoglobinemia. Cornea. 2014 Apr. 33(4):422-4. [QxMD MEDLINE Link].

69. Yusim Y, Livingstone D, Sidi A. Blue dyes, blue people: the systemic effects of blue dyes when administered via different routes. J Clin Anesth. 2007 Jun. 19(4):315-21. [QxMD MEDLINE Link].

70. Masavkar SS, Mauskar A, Patwardhan G, Bhat V, Manglani MV. Acquired Methemoglobinemia - A Sporadic Holi Disaster. Indian Pediatr. 2017 Jun 15. 54 (6):473-475. [QxMD MEDLINE Link].

71. Kohli-Kumar M, Zwerdling T, Rucknagel DL. Hemoglobin F-Cincinnati, alpha 2G gamma 2 41(C7) Phe-->Ser in a newborn with cyanosis. Am J Hematol. 1995 May. 49(1):43-7. [QxMD MEDLINE Link].

72. Iolascon A, et al; SWG of red cell and iron of EHA and EuroBloodNet. Recommendations for diagnosis and treatment of methemoglobinemia. Am J Hematol. 2021 Dec 1. 96 (12):1666-1678. [QxMD MEDLINE Link]. [Full Text].

73. Faust AC, Guy E, Baby N, Ortegon A. Local Anesthetic-Induced Methemoglobinemia During Pregnancy: A Case Report and Evaluation of Treatment Options. J Emerg Med. 2018 May. 54 (5):681-684. [QxMD MEDLINE Link].

74. US Food and Drug Administration. FDA Drug Safety Communication: Updated information about the drug interaction between methylene blue (methylthioninium chloride) and serotonergic psychiatric medications. Available at http://www.fda.gov/Drugs/DrugSafety/ucm263190.htm. December 11, 2017; Accessed: December 21, 2020.

75. Martinez A, Sanchez-Valverde F, Gil F, Clerigué N, Aznal E, Etayo V, et al. 78 Cases Of Methemoglobinemia Induced By Vegetable Intake In Infants In North Spain. A Case-Control Study. J Pediatr Gastroenterol Nutr. 2013 Jan 1. [QxMD MEDLINE Link].

76. Bergamaschi MM, Alcantara GK, Valério DA, Queiroz RH. Curcumin could prevent methemoglobinemia induced by dapsone in rats. Food Chem Toxicol. 2011 Jul. 49(7):1638-41. [QxMD MEDLINE Link].

Khaled F Abouelezz, MBChB Fellow in Hematology and Oncology, University of Cincinnati College of Medicine

Khaled F Abouelezz, MBChB is a member of the following medical societies: American Society for Transplantation and Cellular Therapy, American Society of Clinical Oncology, American Society of Hematology, Egyptian Medical Syndicate

Disclosure: Nothing to disclose.

Ronald A Sacher, MD, FRCPC, DTM&H Professor Emeritus of Internal Medicine and Hematology/Oncology, Emeritus Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center

Ronald A Sacher, MD, FRCPC, DTM&H is a member of the following medical societies: American Association for the Advancement of Science, American Association of Blood Banks, American Clinical and Climatological Association, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society of Blood Transfusion, International Society on Thrombosis and Haemostasis, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

Mudra Kumar, MD, MRCP, FAAP Professor of Pediatrics, Course Director, Course 6 MSII, Preclerkship Director, Clinical Integration, Department of Pediatrics, University of South Florida Morsani College of Medicine

Mudra Kumar, MD, MRCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Mary Denshaw-Burke, MD, FACP Clinical Assistant Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Clinical Assistant Professor, Affiliated Clinical Faculty of the Lankenau Institute for Medical Research; Program Director of Hematology/Oncology Fellowship, Education Coordinator for Oncology, Lankenau Medical Center

Mary Denshaw-Burke, MD, FACP is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Deric C Savior, MD Fellow, Department of Hematology/Oncology, Lankenau Hospital

Disclosure: Nothing to disclose.

Amy Lawser Curran, MD Fellow, Department of Hematology/Oncology, Lankenau Hospital

Amy Lawser Curran, MD is a member of the following medical societies: Alpha Omega Alpha, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Elizabeth DelGiacco, DO Chief Fellow, Department of Hematology/Oncology, Main Line Health, Lankenau Medical Center

Elizabeth DelGiacco, DO is a member of the following medical societies: American Society of Hematology, American Society of Clinical Oncology

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.

Matthew Bouchard, MD Consulting Staff, Department of Emergency Medicine, Altoona Regional Health System

Disclosure: Nothing to disclose.

Michael J Burns, MD Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Marcel E Conrad, MD Distinguished Professor of Medicine (Retired), University of South Alabama College of Medicine

Marcel E Conrad, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Blood Banks, American Chemical Society, American College of Physicians, American Physiological Society, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Association of Military Surgeons of the US, International Society of Hematology, Society for Experimental Biology and Medicine, and Southwest Oncology Group

Disclosure: Nothing to disclose.

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.

Kathy L Ferguson, DO Attending Physician, Department of Emergency Medicine, New York Hospital of Queens

Kathy L Ferguson, DO is a member of the following medical societies: American College of Emergency Physicians and American College of Medical Toxicology

Disclosure: Nothing to disclose.

Lance W Kreplick, MD, FAAEM, MMM Medical Director of Hyperbaric Medicine, Fawcett Wound Management and Hyperbaric Medicine; Consulting Staff in Occupational Health and Rehabilitation, Company Care Occupational Health Services; President and Chief Executive Officer, QED Medical Solutions, LLC

Lance W Kreplick, MD, FAAEM, MMM, is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physician Executives

Disclosure: Nothing to disclose.

David C Lee, MD Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School

David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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.

Paul Schick, MD Emeritus Professor, Department of Internal Medicine, Jefferson Medical College of Thomas Jefferson University; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital

Paul Schick, MD is a member of the following medical societies: American College of Physicians and American Society of Hematology

Disclosure: Nothing to disclose.

John Schoffstall, MD Associate Professor, Department of Emergency Medicine, Medical College of Pennsylvania

John Schoffstall, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

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.

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.

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