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

Abstract

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