Grenz Phillip M, Ray Robert N, Hardy Olivia A, Koons Andrew L, Katz Kenneth D, Romano Teresa M
Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, USF Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown 18103, PA, USA.
Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Division of Toxicology, USF Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown 18103, PA, USA.
Case Rep Pediatr. 2020 Nov 20;2020:8896754. doi: 10.1155/2020/8896754. eCollection 2020.
Methemoglobinemia results from increased amounts of oxidized hemoglobin in the blood with an ensuing change in oxygen dissociation curve and lack of oxygen delivery to tissue. A previously well, male toddler was brought to the Pediatric Emergency Department (PED) by Emergency Medical Services (EMS) with abrupt onset of altered mental status and cyanosis after a suspected ingestion of "Rush" nail polish remover. He was quickly diagnosed with methemoglobinemia by both clinical presentation and chocolate-colored blood appearance. He emergently received intravenous (IV) methylene blue (MB) with immediate and sustained improvement requiring no further doses. Though inhalation of nitrites and subsequent methemoglobinemia is frequently reported in adolescents, we were unable to find any cases in the literature detailing ingestion of this product and the resulting clinical manifestations. Our objective with this report is to describe a rare case of a toddler with an accidental ingestion of "Rush" nail polish remover, a nitrite compound. Our patient presented to the PED with abrupt onset of altered level of consciousness, hypotension, and cyanosis resulting from acquired methemoglobinemia. This case report demonstrates the importance of emergency clinicians being able to make clinical judgements and decisions based on the history and physical exam when methemoglobinemia is suspected.
高铁血红蛋白血症是由于血液中氧化血红蛋白含量增加，随之氧解离曲线发生变化，且组织无法获得氧气供应所致。一名既往健康的男童被紧急医疗服务（EMS）送至儿科急诊科（PED），在疑似摄入“Rush”牌洗甲水后，突然出现精神状态改变和发绀。根据临床表现和血液呈巧克力色外观，他很快被诊断为高铁血红蛋白血症。他紧急接受了静脉注射亚甲蓝（MB）治疗，症状立即得到持续改善，无需再次用药。尽管青少年中经常报告有吸入亚硝酸盐及随后发生高铁血红蛋白血症的情况，但我们在文献中未能找到任何详细描述摄入该产品及其临床表现的病例。我们撰写本报告的目的是描述一例幼儿意外摄入“Rush”牌洗甲水（一种亚硝酸盐化合物）的罕见病例。我们的患者因获得性高铁血红蛋白血症而突然出现意识水平改变、低血压和发绀，并被送至儿科急诊科。本病例报告表明，当怀疑发生高铁血红蛋白血症时，急诊临床医生能够根据病史和体格检查做出临床判断和决策非常重要。
