The following is the summary of “A rare combination of methemoglobinemia and carboxyhemoglobinemia in pesticide poisoning” published in the December 2022 issue of Emergency medicine by Arva, et al.

Disorders known as dyshemoglobinemia occur when hemoglobin is structurally modified and thus unable to transport oxygen. Carboxyhemoglobin, methemoglobin, and sulfhemoglobin are all forms of hemoglobin. Increased aberrant hemoglobin decreases oxygen binding capacity, reducing the blood’s total oxygen content and causing hypoxia. Many systemic and potentially fatal consequences result from the anaemic hypoxia present in these illnesses, and this hypoxia is resistant to oxygen treatment.

Both hemoglobins have been documented in numerous cases across the literature. However, in the same patient, 2 abnormal hemoglobin values are quite unusual. In this article, researchers  describe a rare instance in which a person attempted suicide by ingesting pesticide and was brought to their university-level medical center. Presenting symptoms included extreme pallor, cyanosis of the periphery, rapid breathing and a racing heart, and vertigo. Methemoglobinemia and carboxyhemoglobinemia were verified on arterial blood gas analysis, which investigators suspected based on the SpO2 of 85%. Although she was in a critical condition, the patient was stabilized using High flow nasal cannula (HFNC) oxygen, methylene blue, and a blood transfusion. 

The patient’s symptoms improved over a week, and he was discharged without neurological or cardiorespiratory complications. The key to success was forming a hunch early on and implementing a unique emergency response plan. The shift toward more precise and individualized medical practice is being seen across all medicine, including Emergency Medicine.

Source: sciencedirect.com/science/article/abs/pii/S0735675722005824