Methemoglobinemia differential diagnosis: Difference between revisions

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{{Methemoglobinemia}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Methemoglobinemia]]
{{CMG}} {{AE}}
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==Overview==
==Overview==


==Differential Diagnosis==
Methemoglobinemia must be differentiated from other diseases that cause [[hypoxia]] and [[cyanosis]], such as [[heart failure]], [[pulmonary embolism]], [[polycythemia]], [[anemia]], etc.
 
Since the initial symptoms of methemoglobinemia can be equivocal, this condition can be easily misdiagnosed or even unrecognized. Symptoms correlate to the methemoglobin level and include skin and blood color changes at levels up to 15%. Neurologic and cardiac symptoms, as a result of hypoxia, are observed as levels rise above 15%. Levels higher than 70% are generally fatal.  


Cyanosis that is unresponsive to oxygen treatment is the main physical finding in people with methemoglobinemia and it is due to different absorption spectrum of methemoglobin compared to normal hemoglobin. Apart from MetHb, cyanosis is also seen in people with increased levels of sulfhemoglobin, or in those undergoing treatment of MetHb with Methylene blue. Methylene blue can actually cause cyanotic discoloration to the skin, and this is important to know as it should not be perceived as a therapy failure. Cyanosis accompanied by hypoxia is usually caused by cardiac or pulmonary disease.  
==Differentiating Methemoglobinemia from other Diseases==
*There are several conditions that can present similar to methemoglobinemia. Note that the hypoxia in methemogobinemia will be unresponsive to oxygen treatment, in comparison to cardiac and pulmonary cause. Worth mentioning is that high doses of antidotal treatment for methemogobinemia (Methylene blue) can also cause cyanotic discoloration of the skin, but this does not mean the the treatment is not working.  


*Methemoglobinemia can present with similar signs and symptoms of other conditions causing hypoxia (as listed below). Note that the [[hypoxia]] in [[methemogobinemia]] will be unresponsive to [[oxygen]] treatment, in comparison to cardiac and pulmonary causes of [[hypoxia]].


Differential Diagnoses
• [[Heart failure]]


• Heart failure
• [[Pulmonary embolism]]


• Pulmonary embolism
• [[Polycythemia]]<ref name="pmid29721250">{{cite journal| author=Soliman DS, Yassin M| title=Congenital methemoglobinemia misdiagnosed as polycythemia vera: Case report and review of literature. | journal=Hematol Rep | year= 2018 | volume= 10 | issue= 1 | pages= 7221 | pmid=29721250 | doi=10.4081/hr.2018.7221 | pmc=5907642 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29721250  }} </ref>
• [[Anemia]]


• Polycythemia
• [[Rasbirucase]] (Rx [[Tumor Lysis Syndrome]]) <ref name="pmid28078984">{{cite journal| author=Khan M, Paul S, Farooq S, Oo TH, Ramshesh P, Jain N| title=Rasburicase-Induced Methemoglobinemia in a Patient with Glucose-6- Phosphate Dehydrogenase Deficiency. | journal=Curr Drug Saf | year= 2017 | volume= 12 | issue= 1 | pages= 13-18 | pmid=28078984 | doi=10.2174/1574886312666170111151246 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28078984  }} </ref>


• Anemia
• [[Metabolic Acidosis]]


• Metabolic Acidosis
• [[Methylene Blue treatment]]


• Methylene blue treatment
• [[Sulfhemoglobin]]


• Sulfhemoglobin
• [[Asthma]]


• Asthma
*High doses of [[antidote treatment]] for [[methemogobinemia]] - ([[Methylene blue]]) can also cause [[cyanotic discoloration of the skin]] as a side effect, but this should not lead you into thinking that the treatment is inefficient. <ref name="pmid19082413">{{cite journal| author=do Nascimento TS, Pereira RO, de Mello HL, Costa J| title=Methemoglobinemia: from diagnosis to treatment. | journal=Rev Bras Anestesiol | year= 2008 | volume= 58 | issue= 6 | pages= 651-64 | pmid=19082413 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19082413  }} </ref>


• Anaphylaxis
*Depending on the levels of [[MetHb]] in the [[blood]] we can observe different clinical presentation as follows<ref name="pmid19082413">{{cite journal| author=do Nascimento TS, Pereira RO, de Mello HL, Costa J| title=Methemoglobinemia: from diagnosis to treatment. | journal=Rev Bras Anestesiol | year= 2008 | volume= 58 | issue= 6 | pages= 651-64 | pmid=19082413 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19082413  }} </ref>  <ref name="pmid14579544">{{cite journal| author=Bradberry SM| title=Occupational methaemoglobinaemia. Mechanisms of production, features, diagnosis and management including the use of methylene blue. | journal=Toxicol Rev | year= 2003 | volume= 22 | issue= 1 | pages= 13-27 | pmid=14579544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14579544  }} </ref>
:
*MetHb levels of 15% lead to skin and blood color (chocolate-brown) changes .
*MetHb levels above 15% lead to [[hypoxia]].
*MetHb levels above 70% lead to death.


==References==
==References==

Latest revision as of 21:53, 27 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aksiniya Stevasarova, M.D.

Overview

Methemoglobinemia must be differentiated from other diseases that cause hypoxia and cyanosis, such as heart failure, pulmonary embolism, polycythemia, anemia, etc.

Differentiating Methemoglobinemia from other Diseases

  • There are several conditions that can present similar to methemoglobinemia. Note that the hypoxia in methemogobinemia will be unresponsive to oxygen treatment, in comparison to cardiac and pulmonary cause. Worth mentioning is that high doses of antidotal treatment for methemogobinemia (Methylene blue) can also cause cyanotic discoloration of the skin, but this does not mean the the treatment is not working.
  • Methemoglobinemia can present with similar signs and symptoms of other conditions causing hypoxia (as listed below). Note that the hypoxia in methemogobinemia will be unresponsive to oxygen treatment, in comparison to cardiac and pulmonary causes of hypoxia.

• Heart failure

• Pulmonary embolism

• Polycythemia[1] • Anemia

• Rasbirucase (Rx Tumor Lysis Syndrome) [2]

• Metabolic Acidosis

• Methylene Blue treatment

• Sulfhemoglobin

• Asthma

  • Depending on the levels of MetHb in the blood we can observe different clinical presentation as follows[3] [4]
  • MetHb levels of 15% lead to skin and blood color (chocolate-brown) changes .
  • MetHb levels above 15% lead to hypoxia.
  • MetHb levels above 70% lead to death.

References

  1. ↑ Soliman DS, Yassin M (2018). "Congenital methemoglobinemia misdiagnosed as polycythemia vera: Case report and review of literature". Hematol Rep. 10 (1): 7221. doi:10.4081/hr.2018.7221. PMC 5907642. PMID 29721250.
  2. ↑ Khan M, Paul S, Farooq S, Oo TH, Ramshesh P, Jain N (2017). "Rasburicase-Induced Methemoglobinemia in a Patient with Glucose-6- Phosphate Dehydrogenase Deficiency". Curr Drug Saf. 12 (1): 13–18. doi:10.2174/1574886312666170111151246. PMID 28078984.
  3. ↑ 3.0 3.1 do Nascimento TS, Pereira RO, de Mello HL, Costa J (2008). "Methemoglobinemia: from diagnosis to treatment". Rev Bras Anestesiol. 58 (6): 651–64. PMID 19082413.
  4. ↑ Bradberry SM (2003). "Occupational methaemoglobinaemia. Mechanisms of production, features, diagnosis and management including the use of methylene blue". Toxicol Rev. 22 (1): 13–27. PMID 14579544.

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