Acute severe methemoglobinemia caused by accidental liquid shoe shiner ingestion: A case report and review of literature

Nitrobenzene, an aromatic compound is responsible for a lethal condition called methemoglobinemia. Nitrobenzene toxicity results from inhalation, ingestion, and skin contamination. It oxidizes Fe in the Hb and converts it into methemoglobin. The normal level of MetHb in the blood is 1 % and is maintained by RBCs. Greater production of MetHb than what can be maintained by RBCs results in Methemoglobinemia rendering Hb unable to deliver oxygen to tissues. Our report portrays the case of a 25-year-old male who ingested an unknown substance and presented with cyanosis and vomiting, having a bitter almond odor. Blood drawn for labs revealed chocolate color, a classic representation of methemoglobinemia. Treatment includes oxygen therapy, gastric lavage, IV methylene blue and if it's not available, an exchange transfusion can be done. Early identification of the condition is crucial for reducing morbidity and mortality. Businesses dealing with such toxic chemicals should be asked to maintain regular exposure checkups and plans available for ready access to medical management in case of emergency.