Survival With 98% Methemoglobin Levels in a School-Aged Child During the "Festival of Colors"

Abstract: Methemoglobin levels more than 70% have almost alwaysbeen reported to have been fatal. The case of a 4-year-old boy who sur-vived with methemoglobin levels of 98% is presented here. He wasbrought to the emergency department with complaints of vomiting, painabdomen, and altered sensorium following accidental ingestion of paintthinner mixed with ‘‘Holi’’ colors. On examination, the child was in al-tered sensorium, cyanosed with saturations of 55%, who did not responddespite positive pressure ventilation with 100% oxygen. A possibility oftoxic methemoglobinemia was considered and confirmed by finding ofelevated methemoglobin levels of 98%. The child survived with defini-tive therapy with methylene blue and aggressive goal-directed approach.Key Words: methemoglobinemia, Holi, methylene blue, paint thinner(Pediatr Emer Care 2013;29: 1102Y1103) CASE A 4-year-old school-aged child was brought to the emer-gency with altered sensorium, vomiting, and diffuse abdominalpain 30 minutes after ingestion of approximately 5 mL of paintthinner mixedwith ‘‘gulal’’ (powderedcolor used toplay ‘‘Holi,’’the‘‘festivalofcolors’’). Thereasonbehindhow thepaint thinnerhad got contaminated with ‘‘Holi’’ colors was not forthcomingfrom the history. The child had assumed it to be some kind ofa beverage and consumed it. He was brought in 2 hours afterthe alleged poisoning. On examination, he was afebrile with apulse rateof156 beats/minand respiratoryrateof46 breaths/minwith subcostal and intercostal retractions. The child had centralcyanosis with a Sp