Reactions 1680, p273 - 2 Dec 2017
Methaemoglobinaemia: case report
A 78-year-old woman developed methaemoglobinaemia
following paracetamol administration [acetaminophen; time
to reaction onset not stated].
The woman had autosomal dominant polycystic kidney
disease for which she was on haemodialysis for 30 months and
mild cognitive impairment due to vascular dementia. She was
treated with aspirin [acetylsalicylic acid], calcium acetate/
magnesium carbonate, hydroxyzine and quetiapine. She went
to hospital after appearance of a diffuse brownish skin tone.
She had haemodialysis the previous day, after which she took
oral paracetamol 1g for elevation in axillary temperature. Later,
she reported intake of paracetamol 1 g three times daily for
previous 7 days for osteoarticular complaints. Increase in
percent of methaemoglobin (3.3%) was observed in arterial
blood gas analysis, and blood analysis revealed normochromic
normocytic anemia with haemoglobin 11.2 g/dL. The 5
sample of blood biochemistry revealed increase in alanine
aminotransferase 62 U/L and total bilirubin 1.62 mg/dL.
The diagnosis of paracetamol-related methemoglobinemia
was suspected and paracetamol was stopped. After 2 days,
bluish skin colour was observed and blood analysis revealed
decrease in percent of methaemoglobin (2.9%). Increase in
bilirubin and hepatic cytolysis enzymes were noted by
analytical study, which supported the diagnosis of
paracetamol-related methemoglobinemia. She was discharged
and reassessment after 9 days showed improvement in skin
colour and no significant changes were noted in analytical
study. The blood gas analysis showed normal percentage of
Author comment: "Methemoglobinemia is a potentially
fatal condition, mainly acquired after intoxication by certain
drugs. To this date, only three cases associated with
paracetamol have been reported." "The diagnosis of
paracetamol-related methemoglobinemia was suspected, and
the patient immediately stopped taking this drug".
Queiros C, et al. Methemoglobinemia after paracetamol ingestion: A case report.
Acta Medica Portuguesa 30: 753-756, No. 10, Oct 2017. Available from: URL:
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Reactions 2 Dec 2017 No. 16800114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved