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Published 28 April 2009
Cite this as: BMJ Case Reports 2009 [doi:10.1136/bcr.07.2008.0515]
Copyright © 2009 by the BMJ Publishing Group Ltd.

Reminder of important clinical lesson

Acute methaemoglobinaemia after massive nitrobenzene ingestion

Mark Perera, Fatima Shihana, Keerthi Kularathne, Damika Dissanayake, Andrew Dawson

SACTRC, Peradeniya, Peradeniya, 091, Sri Lanka

Correspondence to:
Mark Perera, mark{at}sactrc.org

SUMMARY

Flower-N is a flowering stimulant composition with 22% nitrobenzene. The main systemic effect associated with human exposure to nitrobenzene is methaemoglobinaemia. A 25-year-old female presented after 3 hours following ingestion of 100 ml of 22% Nitrobenzene (Flower-N). Her initial methaemoglobin (MetHb) was 81%; this responded to methylene blue. However, she developed recurrent methaemoglobinaemia on days 3 and 5 with haemolytic anaemia. The treatments that were provided were repeated methylene blue treatment and exchange transfusion. Nitrobenzene ingestion is a known cause of methaemoglobinaemia and haemolytic anaemia. The recurrence suggests a long half-life. The recurrent MetHb has clinical implications as patients may require repeated treatment. Massive nitrobenzene ingestion can cause haemolysis and recurrent methaemoglobinaemia.


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