Faculty Collaboration Database

A Case Report of Hypotension and Methemoglobinemia Associated With Gunshot Residue Poisoning: Nitrite-Induced Methemoglobinemia. A A Pract 2022 Oct 01;16(10):e01631

Date

01/05/2023

Pubmed ID

36599025

DOI

10.1213/XAA.0000000000001631

Scopus ID

2-s2.0-85145535097 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

A patient with gunshots within inches of the skin developed intraoperative vasodilatory hypotension and methemoglobinemia, both recognized consequences of nitrite poisoning. A 1- mg/kg dose of methylene blue transiently and partially reversed methemoglobinemia, but the color of the methylene blue faded rapidly, consistent with bleaching of methylene blue by nitrite in vivo. Methylene blue did not raise blood pressure, consistent with inhibition of nitric oxide (NO) synthase. Because NO production from nitrite uses an NO synthase (NOS)-independent pathway, methylene blue is expected to have little effect on reversing hypotension from nitrite poisoning. Consider nitrite toxicity in gunshot patients with refractory vasodilatory hypotension and elevated methemoglobin.

Author List

Pugh DB, Saxena A, Barta LE, Pinkerton C, Bajic J, Boettcher BT, Woehlck HJ

Authors

Brent Boettcher DO Associate Professor in the Anesthesiology department at Medical College of Wisconsin
Harvey J. Woehlck MD Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Humans
Hypotension
Methemoglobin
Methemoglobinemia
Methylene Blue
Nitrites
Wounds, Gunshot