• A&A practice · Oct 2022

    Case Reports

    A Case Report of Hypotension and Methemoglobinemia Associated With Gunshot Residue Poisoning: Nitrite-Induced Methemoglobinemia.

    • David B Pugh, Aakash Saxena, Lauren E Barta, Carolyn Pinkerton, Jurica Bajic, Brent T Boettcher, and Harvey J Woehlck.
    • From the Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
    • A A Pract. 2022 Oct 1; 16 (10): e01631e01631.

    AbstractA 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.Copyright © 2022 International Anesthesia Research Society.

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