Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2024; 12(22): 5151-5158
Published online Aug 6, 2024. doi: 10.12998/wjcc.v12.i22.5151
Acquired methemoglobinemia in a third trimester puerpera and her premature infant with sodium nitrite poisoning: A case report
Dong-Sheng Fei, Yang Gao, Xue-Jiao Bao, Yu-Jia Tang, Yi-Lu Lin, Jia-Xi Xu, Jia-Ning Zhang, Bo-Wen Liu, Kai Kang
Dong-Sheng Fei, Xue-Jiao Bao, Yu-Jia Tang, Jia-Xi Xu, Jia-Ning Zhang, Bo-Wen Liu, Kai Kang, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
Yang Gao, Yi-Lu Lin, Department of Critical Care Medicine, The Sixth Affiliated Hospital of Harbin Medical University, Harbin 150027, Heilongjiang Province, China
Author contributions: Fei DS, Gao Y, and Kang K participated in the literature search, conception, and manuscript preparation, editing, and review; Bao XJ, Tang YJ, Lin YL, Xu JX, Zhang JN, and Liu BW provided assistance for the literature search, conception, and manuscript preparation; All authors contributed to the article and approved the submitted version; Fei DS and Gao Y have contributed equally to this work.
Supported by the National Natural Science Foundation of China, No. 82372172; the Key Research and Development Plan Project of Heilongjiang Province, No. GA23C007; the Heilongjiang Province Postdoctoral Start-up Fund, No. LBH-Q20037; the Research Project of Heilongjiang Provincial Health Commission, No. 20231717010461; the Special Fund for Clinical Research of Wu Jie-ping Medical Foundation, No. 320.6750.2022-02-16; and the Scientific Research Innovation Fund of the First Affiliated Hospital of Harbin Medical University, No. 2021M08.
Informed consent statement: The authors extend their gratitude to all those who provided valuable assistance, guidance, and support for this article.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kai Kang, MD, Chief Doctor, Doctor, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Harbin 150001, Heilongjiang Province, China. janekk1021@126.com
Received: February 26, 2024
Revised: April 25, 2024
Accepted: June 5, 2024
Published online: August 6, 2024
Processing time: 126 Days and 20.1 Hours
Abstract
BACKGROUND

The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of suicide/exit. The subsequent formation of methemoglobin (MetHb) restricts oxygen transport and utilization in the body, resulting in functional hypoxia at the tissue level. In clinical practice, a mismatch of cyanotic appearance and oxygen partial pressure usually contributes to the identification of methemoglobinemia. Prompt recognition of characteristic mismatch and accurate diagnosis of sodium nitrite poisoning are prerequisites for the implementation of standardized systemic interventions.

CASE SUMMARY

A pregnant woman was admitted to the Department of Critical Care Medicine at the First Affiliated Hospital of Harbin Medical University due to consciousness disorders and drowsiness 2 h before admission. Subsequently, she developed vomiting and cyanotic skin. The woman underwent orotracheal intubation, invasive mechanical ventilation (IMV), and correction of internal environment disturbance in the ICU. Her premature infant was born with a higher-than-normal MetHb level of 3.3%, and received detoxification with methylene blue and vitamin C, supplemental vitamin K1, an infusion of fresh frozen plasma, as well as respiratory support via orotracheal intubation and IMV. On day 3 after admission, the puerpera regained consciousness, evacuated the IMV, and resumed enteral nutrition. She was then transferred to the maternity ward 24 h later. On day 7 after admission, the woman recovered and was discharged without any sequelae.

CONCLUSION

MetHb can cross through the placental barrier. Level of MetHb both reflects severity of the sodium nitrite poisoning and serves as feedback on therapeutic effectiveness.

Keywords: Sodium nitrite poisoning; Methemoglobinemia; Methemoglobin; Third trimester puerpera; Premature infant; Placental barrier; Methylene blue; Case report

Core Tip: This study is the first to present rare cases of acquired methemoglobinemia in pregnant women in the third trimester of pregnancy and in premature infants with high suspicion of sodium nitrite poisoning, revealing that methemoglobin (MetHb) can quickly cross the placental barrier. MetHb levels not only reflect the severity of sodium nitrite poisoning, but also serve as feedback on the effectiveness of treatment. However, fatal outcomes in patients with sodium nitrite poisoning are related to potential comorbidities of poor health at advanced age and worsening organ function, not just the poisoning itself, which requires greater attention from medical personnel.