Case Study: Cyanosis - page 2

by blondy2061h 5,425 Views | 20 Comments

Juan de la Cruz's excellent case studies lately has inspired me to share an interesting one I saw several years ago. The details have been changed to protect privacy, but the foundation of the case is based on a real patient. I... Read More


  1. 2
    methemogloginemia!!! needs methylene blue! only saw this once in 22yrs of nursing!
    Enthused RN and blondy2061h like this.
  2. 1
    Quote from skoolrn
    methemogloginemia!!! needs methylene blue! only saw this once in 22yrs of nursing!
    This is the best answer EVER!! Smarty pants! LOLOLOL
    However, is this diagnosed with iron studies?
    blondy2061h likes this.
  3. 1
    I think once they see brownish blood it's a dead giveaway (No pun intended)! Now what's the cause?
    blondy2061h likes this.
  4. 1
    Posting from my phone, but wanted to let everyone know you're all largely right. This case was complicated and a bit baffling because she had both pericarditis with an associated pericardial effusion AND methemoglobinemia. Two major acute conditions! I'll post more details later.
    Enthused RN likes this.
  5. 1
    If anyone can guess cause of the methemoglobinemia you get major points!
    jadelpn likes this.
  6. 1
    I'm going to guess the local anesthetic for the dental extractions.
    blondy2061h likes this.
  7. 1
    w/u for suspected methemoglobinemia?
    blondy2061h likes this.
  8. 1
    Exposure to:
    benzene,
    antibiotics like dapsone or chloroquine,
    nitrities (which are sometimes use to keep meat from spoiling) or
    anesthetics like benzocaine and xylocaine.
    blondy2061h likes this.
  9. 0
    The patient continues to be immunosuppressed related to functional asplenia due to transplant, continued systemic immunosuppression for control of her chronic GVHD symptoms, and intermittent steroid use for worsening GVHD flares. As such, she requires PCP prophylaxis and due to intolerance was on Dapsone for this purpose- a drug known to increase risk for methemoglobinemia. She was tolerating this well in and of itself, but then received Novocaine for the dental extractions and used Orajel (benzocaine) at home for pain management. The combination lead to the methemoglobinemia.

    The methemoglobinemia was confirmed as a moderate case via the potassium cyanide test.

    Echocardiogram showed the pericardial effusion, mild mitral valve regurgitation, and an ejection fraction of 60%.

    Given all of these issues, what treatment would you anticipate? How would response to therapy be monitored?
  10. 0
    Hmmm...

    pericardiocentesis and examination of fluid. ?idiopathic pericardial effusion due to HVGD

    O2 support, pain meds, treat the methemoglobinemia, low dose diuretic
    labs: Hb M, CBC, chem panel; cardiac ultrasounds.


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