Methemoglobinemia in a child induced by metoclopramide: a clinical case

Abstract

Introduction. Methemoglobinemia is a rare condition characterized by an elevated level of methemoglobin in the blood, leading to chemical hypoxia. The most common symptom is central cyanosis refractory to oxygen therapy. Diagnosis of methemoglobinemia is difficult due to the nonspecific clinical presentation and lack of awareness. Accurate diagnosis requires a thorough medical history, differential diagnosis, and confirmation through laboratory investigations.The objective was to demonstrate the successful use of ascorbic acid in the management of acute secondary methemoglobinemia in an 11-year-old boy on prolonged metoclopramide therapy.Materials and methods. The retrospective analysis was conducted on the clinical course of acute secondary methemoglobinemia in the 11-year-old boy on prolonged metoclopramide therapy, necessitating oxygen therapy and parenteral administration of ascorbic acid solution. Special attention was given to the clinical presentation, characteristic changes in laboratory parameters, and the effectiveness of timely ascorbic acid therapy. Clinical and laboratory improvement was achieved within 24 hours of treatment initiation.Conclusion. Caution should be exercised when prescribing medications that can induce methemoglobinemia, taking into account dosage, duration, and frequency of use. Furthermore, careful attention should be given to the combination of metoclopramide with other drugs that may affect iron heme oxidation reactions.