Methemoglobinemia differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
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Overview
Differential Diagnosis
Since the initial symptoms of methemoglobinemia can be equivocal, this condition can be easily misdiagnosed or even unrecognized. Symptoms correlate to the methemoglobin level and include skin and blood color changes at levels up to 15%. Neurologic and cardiac symptoms, as a result of hypoxia, are observed as levels rise above 15%. Levels higher than 70% are generally fatal.
Cyanosis that is unresponsive to oxygen treatment is the main physical finding in people with methemoglobinemia and it is due to different absorption spectrum of methemoglobin compared to normal hemoglobin. Apart from MetHb, cyanosis is also seen in people with increased levels of sulfhemoglobin, or in those undergoing treatment of MetHb with Methylene blue. Methylene blue can actually cause cyanotic discoloration to the skin, and this is important to know as it should not be perceived as a therapy failure. Cyanosis accompanied by hypoxia is usually caused by cardiac or pulmonary disease.
Differential Diagnoses
• Heart failure
• Pulmonary embolism
• Polycythemia
• Anemia
• Metabolic Acidosis
• Methylene blue treatment
• Sulfhemoglobin
• Asthma
• Anaphylaxis