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Year : 2020  |  Volume : 18  |  Issue : 3  |  Page : 175-178

Acquired methemoglobinemia in cases of intentional exposure to agrochemicals: Our 4 years experience

Department of Emergency Medicine, CMC, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. Darpanarayan Hazra
Department of Emergency Medicine, CMC, Vellore - 632 004, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cmi.cmi_3_20

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Background: Intentional exposure to agrochemicals is a major cause of premature mortality globally. Many such agrochemical compounds contain solvents that may result in severe methemoglobinemia that may be fatal. Acute methemoglobinemia is usually associated with high mortality; hence, an early aggressive management of poisoning in the emergency department (ED) should be attempted. Materials and Methods: This was a single-center, retrospective, cohort study analyzing patients with a history of ingestion of agrochemicals and significant methemoglobinemia in a period of 4 years that presented to our ED. Results: The total number of patients presenting to the ED following ingestion of agrochemicals with a motive of deliberate self-harm was 2491 during the 4-year study period, among which 24 patients had significant levels of methemoglobin. Majority of the patients presented following ingestion of nitrobenzene compounds (37%), followed by organic herbicides and larvicidal compounds (17%). The most common clinical features were that of low oxygen saturation on pulse oximetry not improving with oxygen therapy and central cyanosis. Most of these patients, i.e., 91.6%, were treated with intravenous (IV) methylene blue, to which 81.8% patients responded favorably and had methemoglobin <20% at 1-h interval from administering. Among the total study population, most (83.3%) patients required admission in the ward or intensive care for further stabilization and management, whereas the rest (16.7%) opted for discharge against medical advice. There was no mortality in the ED. Conclusions: Methemoglobinemia can be caused by a wide variety of agrochemicals that are potentially life-threatening. The most common clinical signs in the ED are those relating to hypoxemia. Use of IV methylene blue resulted in a significant reduction of methemoglobinemia. With this characterization, we hope to guide protocols in the future for the management of agrochemical poisoning.

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