Methemoglobinemia laboratory findings: Difference between revisions

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{{Methemoglobinemia}}
{{Methemoglobinemia}}
{{CMG}}; {{AE}}{{Aksiniya K. Stevasarova, M.D.}}
{{CMG}}; {{AE}}{{AKS}}


==Overview==
==Overview==
 
Methemoglobinemia can be diagnosed with several laboratory findings such as ABG analysis, co-oximetry and pulse oximetry.
'''Congenital (Hereditary) Methemoglobinemia'''
 
There are three main congenital conditions that lead to methemoglobinemia:
 
1. Cytochrome b5 reductase deficiency and pyruvate kinase deficiency
 
2. G6PD deficiency
 
3. Presence of abnormal hemoglobin.
 
 
'''Acquired or Acute Methemoglobinemia'''
 
Most common cause include different oxidant drugs, toxins or chemicals


==Laboratory Findings==       
==Laboratory Findings==       
<ref>{{ Rev Bras Anestesiol. 2008 Nov-Dec;58(6):651-64. Methemoglobinemia: from diagnosis to treatment. [Article in English, Portuguese] do Nascimento TS1, Pereira RO, de Mello HL, Costa J.pmid=PMID: 19082413}}</ref>  <ref>{{ Conf Proc IEEE Eng Med Biol Soc. 2017 Jul;2017:4570-4573. doi: 10.1109/EMBC.2017.8037873.
       
Three-wavelength method for the optical differentiation of methemoglobin and sulfhemoglobin in oxygenated blood.
Van Leeuwen SR, Baranoski GVG, Kimmel BW. pmid=29060914 }}</ref>      <ref>{{Toxicol Rev. 2003;22(1):13-27.
Occupational methaemoglobinaemia. Mechanisms of production, features, diagnosis and management including the use of methylene blue.
Bradberry SM1. pmid=14579544}}</ref>    <ref>{{South Med J. 2011 Nov;104(11):757-61. doi: 10.1097/SMJ.0b013e318232139f.
Methemoglobinemia: pathogenesis, diagnosis, and management.
Skold A1, Cosco DL, Klein R. pmid=22024786 }}</ref>
 
 
'''ABG Analysis'''
'''ABG Analysis'''


On routine ABG analysis the partial pressure of oxygen (PO2) value should in normal reference ranges in patients with methemoglobinemia. The reason lies in the fact that the ABG value represents the oxygen content in the plasma, and not the oxygen-carrying capacity of hemoglobin.
*On routine [[ABG analysis]] the [[partial pressure]] of [[oxygen]] ([[PO2]]) value should in normal reference ranges in patients with [[methemoglobinemia]]. The reason lies in the fact that the [[ABG]] value represents the [[oxygen]] content in the [[plasma]], and not the [[oxygen-carrying capacity of hemoglobin]].<ref name="pmid19082413">{{cite journal| author=do Nascimento TS, Pereira RO, de Mello HL, Costa J| title=Methemoglobinemia: from diagnosis to treatment. | journal=Rev Bras Anestesiol | year= 2008 | volume= 58 | issue= 6 | pages= 651-64 | pmid=19082413 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19082413  }} </ref> <ref name="pmid22024786">{{cite journal| author=Skold A, Cosco DL, Klein R| title=Methemoglobinemia: pathogenesis, diagnosis, and management. | journal=South Med J | year= 2011 | volume= 104 | issue= 11 | pages= 757-61 | pmid=22024786 | doi=10.1097/SMJ.0b013e318232139f | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22024786 }} </ref> <ref name="pmid14579544">{{cite journal| author=Bradberry SM| title=Occupational methaemoglobinaemia. Mechanisms of production, features, diagnosis and management including the use of methylene blue. | journal=Toxicol Rev | year= 2003 | volume= 22 | issue= 1 | pages= 13-27 | pmid=14579544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14579544  }} </ref>
 
'''Co-oximetry'''
 
The co-oximeter is the most accurate device to measure methemoglobin. The newer generation devices can actually differentiate between methemoglobin, carboxyhemoglobin, oxyhemoglobin, deoxyhemoglobin, and also
Sulfhemoglobin.
 
'''Pulse oximetry'''
 
The pulse oximetry in methemoglobinemia patients will always show a value around 85%, regardless of the level of MetHb in the blood. This is very importan tot know as this value can be misleading especially in patients with very high MetHb levels
Fortunately new multiwavelength pulse oximeters have been developed recently and they can detect the levels of MetHb more accurately.  
 
In methemoglobinemia patients we often see the so called “saturation gap” which can help us diagnose the condition. The gap is calculated by subtracting the oxygen percentage from the ABG analysis (typically normal in methemoglobinemia patients 100%) from the percentage of oxygen saturation given by the pulse oximeter (always ~85% in methemoglobiemia patients). Saturaion gap more than 5 % is significant.
 
{{Reflist|2}}


==References==
==References==

Latest revision as of 14:03, 15 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aksiniya Stevasarova, M.D.

Overview

Methemoglobinemia can be diagnosed with several laboratory findings such as ABG analysis, co-oximetry and pulse oximetry.

Laboratory Findings

ABG Analysis

References

  1. do Nascimento TS, Pereira RO, de Mello HL, Costa J (2008). "Methemoglobinemia: from diagnosis to treatment". Rev Bras Anestesiol. 58 (6): 651–64. PMID 19082413.
  2. Skold A, Cosco DL, Klein R (2011). "Methemoglobinemia: pathogenesis, diagnosis, and management". South Med J. 104 (11): 757–61. doi:10.1097/SMJ.0b013e318232139f. PMID 22024786.
  3. Bradberry SM (2003). "Occupational methaemoglobinaemia. Mechanisms of production, features, diagnosis and management including the use of methylene blue". Toxicol Rev. 22 (1): 13–27. PMID 14579544.

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