• Fathima Shihana, Dhammika Menike Dissanayake, Nicholas Allan Buckley, and Andrew Hamilton Dawson.
• South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. shihana@sactrc.org
• Ann Emerg Med. 2010 Feb 1; 55 (2): 184-9.

Study ObjectiveMethemoglobinemia after pesticide poisoning is associated with a mortality of 12% in Sri Lanka. Treatment is complicated by the lack of laboratory facilities. We aimed to develop and validate a low-cost bedside test for quantitative estimation of clinically significant methemoglobin to be used in settings of limited resources.MethodsA method to reliably produce blood samples with 10% to 100% methemoglobin was developed. Freshly prepared methemoglobin samples were used to develop the color chart. One drop (10 microL) of prepared methemoglobin sample was placed on white absorbent paper and scanned using a flatbed Cannon Scan LiDE 25 scanner. The mean red, green, and blue values were measured with ImageJ 1.37v. These color values were used to prepare a color chart to be used at the bedside. Interobserver agreement was assessed against prepared samples. The results from clinical use were compared with formal methemoglobin measurements.ResultsThe red color value was linearly related to percentage methemoglobin (R(2)=0.9938), with no effect of absolute hemoglobin concentration. Mean interobserver (N=21) agreement and weighted kappa for scanned methemoglobin spots using the color chart were 94% and 0.83, respectively. Mean interobserver (N=9) agreement and weighted kappa for a freshly prepared methemoglobin sample with the chart were 88% and 0.71, respectively. Clinical use of the color chart also showed good agreement with spectrometric measurements.ConclusionA color chart can be used to give a clinically useful quantitative estimate of methemoglobinemia.Copyright (c) 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

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