Ramtel Rupesh, Adhikari Bibhuti, Shrestha Mijjal, Hirachan Niroj, Poddar Elisha, Shrestha Suraj
Department of Internal Medicine, Sumeru City Hospital, Pulchowk, Kathmandu, Nepal.
Department of Medicine, Amda Hospital, Damak, Nepal.
Ann Med Surg (Lond). 2022 Sep 1;81:104553. doi: 10.1016/j.amsu.2022.104553. eCollection 2022 Sep.
and Importance: Nitrobenzenes are aromatic oxidizing nitrate compounds, acute ingestion of which can cause methemoglobinemia (metHb) that impairs oxygen transport. Clinical presentation ranges from cyanosis to asphyxia depending on the level of methemoglobin in the blood. Lack of improvement of hypoxia despite administration of oxygen can also be a clue to the diagnosis.
A 23-year-old male with accidental ingestion of nitrobenzene presented with multiple episodes of vomiting, headache, and dyspnea. His venous blood was dark brown in color and oxygen saturation was not improving despite high-flow oxygen. He was managed with methylene blue and Vitamin C on this background with an appropriate history of nitrobenzene ingestion.
Acute nitrobenzene poisoning results in methemoglobinemia which is diagnosed by Co-oximeter but in resource-limited settings, clinical findings such as no improvement in SpO despite supplemental oxygen and chocolate brown appearance of blood aid in the diagnosis. Prompt treatment of methemoglobinemia with methylene blue along with Vitamin C has shown successful and effective outcomes.
Diagnosis of acute nitrobenzene poisoning can be made with proper history, physical and bedside examinations in resource-limited settings even without the aid of a co-oximeter.
硝基苯是芳香族氧化性硝酸盐化合物，急性摄入可导致高铁血红蛋白血症（高铁Hb），损害氧运输。临床表现因血液中高铁血红蛋白水平而异，从发绀到窒息不等。尽管给予氧气但缺氧情况仍无改善也可能是诊断线索。
一名23岁男性意外摄入硝基苯后出现多次呕吐、头痛和呼吸困难。他的静脉血呈深棕色，尽管给予高流量氧气，氧饱和度仍未改善。在此背景下，结合适当的硝基苯摄入史，对他使用亚甲蓝和维生素C进行治疗。
急性硝基苯中毒导致高铁血红蛋白血症，通过共血氧计诊断，但在资源有限的环境中，诸如补充氧气后SpO仍无改善以及血液呈巧克力棕色等临床发现有助于诊断。用亚甲蓝和维生素C及时治疗高铁血红蛋白血症已显示出成功且有效的结果。
在资源有限的环境中，即使没有共血氧计的帮助，通过适当的病史、体格检查和床边检查也可诊断急性硝基苯中毒。
