BMJ Case Reports 2017; doi:10.1136/bcr-2017-220802
  • Unusual association of diseases/symptoms

Case of methaemoglobinaemia caused by tree oils and kerosene

  1. Rita Sood
  1. Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Kartik Gupta, kartik.gupta127{at}
  • Accepted 7 September 2017
  • Published 23 September 2017


We report a case of a young man who allegedly consumed 100 mL of an indigenous pesticide which is used for the killing of rats in households in India. The constituents were azadirachtin oil (40%), tea oil (15%), pine oil (25%) and kerosene oil (20%). He presented to us with shortness of breath and altered sensorium and was found to have fMetHb (fraction of methaemoglobin) level of 80%, which has been postulated to have a fatal outcome. He responded to a low dose of methylene blue along with intravenous vitamin C and the level of fMetHb came down to 20% within 1 hour. His sensorium improved markedly with a decrease in fMetHb to non-toxic levels and he was discharged 5 days after admission. A literature review pertaining to these constituents individually or in combination causing methaemoglobinaemia is discussed in the context of this case.


  • Contributors All the four authors contributed to the clinical care of the patient. KG: junior resident in charge. MJ: senior resident in charge. RSJ: assistant professor in charge. RS: professor in charge. All the four authors contributed to the writing of the paper. KG: conceptualised and wrote the first draft. MJ and RSJ: contributed to revisions. RS: contributed to conceptual design, revisions and finalisation of paper.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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