XIV.a
Methemoglobinemia
See also under XIVa. Known since the 1940s (PMID 18883450). Comprehensive list of causal drugs and chemicals available at PMID 1564446. Methemoglobin is the oxidized (Fe3+) species of hemoglobin (Fe2+). Patients present with slate-grey cyanosis, low SpO2, normal SaO2 and PaO2. Normally, methemoglobin is <1%. Levels above 40% can be life-threatening, producing pulmonary edema, cardiovascular collapse (PMID 17122537) CNS disturbances and death. Management includes i.v. methylene blue. A possible rebound increase in MeHb upon treatment requires close monitoring. Excess methylene blue can also produce methemoglobinemia
Causative drugs
85
Gases
I.v
I - Interstitial/parenchymal lung disease
I.v - Abnormal lung function/pulmonary physiology (PFTs) without necessarily imaging or clinical evidence I.af I - Interstitial/parenchymal lung disease
I.af - Chemical (toxic) pneumonitis II.a II - Pulmonary edema - Acute lung injury - ARDS
II.a - Pulmonary edema, noncardiogenic (NCPE) II.b II - Pulmonary edema - Acute lung injury - ARDS
II.b - ARDS - Acute lung injury IV.c IV - Airway involvement
IV.c - Obliterative bronchiolitis (a pattern consistent with) (see also IVn, XVx) IV.e IV - Airway involvement
IV.e - Cough (acute, violent, explosive) IV.p IV - Airway involvement
IV.p - Thermal, chemical or caustic airway injury IV.q IV - Airway involvement
IV.q - Reactive airway dysfunction syndrome (RADS) VII.h VII - Mediastinal involvement
VII.h - Pneumomediastinum VIII.c VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.c - Upper airway obstruction other than angioedema or hematoma IX.t IX - Neuromuscular / CNS involvement - Disordered breathing during sleep
IX.t - CNS involvement/dysfunction/damage XI.s XI - Miscellaneous
XI.s - Sniffing death - Death from inhalation of compound XII.a XII - Cardiovascular involvement / toxicity
XII.a - Left or biventricular dysfunction/failure XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia XIV.c XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.c - Carboxyhemoglobinemia
I.v - Abnormal lung function/pulmonary physiology (PFTs) without necessarily imaging or clinical evidence I.af I - Interstitial/parenchymal lung disease
I.af - Chemical (toxic) pneumonitis II.a II - Pulmonary edema - Acute lung injury - ARDS
II.a - Pulmonary edema, noncardiogenic (NCPE) II.b II - Pulmonary edema - Acute lung injury - ARDS
II.b - ARDS - Acute lung injury IV.c IV - Airway involvement
IV.c - Obliterative bronchiolitis (a pattern consistent with) (see also IVn, XVx) IV.e IV - Airway involvement
IV.e - Cough (acute, violent, explosive) IV.p IV - Airway involvement
IV.p - Thermal, chemical or caustic airway injury IV.q IV - Airway involvement
IV.q - Reactive airway dysfunction syndrome (RADS) VII.h VII - Mediastinal involvement
VII.h - Pneumomediastinum VIII.c VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.c - Upper airway obstruction other than angioedema or hematoma IX.t IX - Neuromuscular / CNS involvement - Disordered breathing during sleep
IX.t - CNS involvement/dysfunction/damage XI.s XI - Miscellaneous
XI.s - Sniffing death - Death from inhalation of compound XII.a XII - Cardiovascular involvement / toxicity
XII.a - Left or biventricular dysfunction/failure XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia XIV.c XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.c - Carboxyhemoglobinemia
2
Hydrocarbons (petrochemicals: petroleum, petrolatum, paraffin, vaseline, naphta, jet fuel (kerosene), Diesel, gasoil), ointments, salad oil, variegated oils, butter). Aspirated
I.b
I - Interstitial/parenchymal lung disease
I.b - Pneumonitis (ILD) I.g I - Interstitial/parenchymal lung disease
I.g - Pulmonary fibrosis I.j I - Interstitial/parenchymal lung disease
I.j - Exogenous lipoid pneumonia (subacute, acute) I.z I - Interstitial/parenchymal lung disease
I.z - An area or areas of consolidation I.ae I - Interstitial/parenchymal lung disease
I.ae - Hydrocarbon pneumonitis I.af I - Interstitial/parenchymal lung disease
I.af - Chemical (toxic) pneumonitis I.ag I - Interstitial/parenchymal lung disease
I.ag - Fire-eater's lung/pneumonitis II.b II - Pulmonary edema - Acute lung injury - ARDS
II.b - ARDS - Acute lung injury III.a III - Pulmonary/alveolar./airway hemorrhage/bleeding
III.a - Alveolar hemorrhage (AH), diffuse AH (DAH) III.c III - Pulmonary/alveolar./airway hemorrhage/bleeding
III.c - Hemoptysis IV.k IV - Airway involvement
IV.k - Bronchiectasis V.a V - Pleural and/or pericardial involvement
V.a - Pleural effusion (uni- or bilateral) (May commpany ILDs) VIII.d VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.d - Thermal (burns, frostbite), chemical or caustic facial and/or airway injury XI.b XI - Miscellaneous
XI.b - Chest pain (acute or subacute), lone or prominent XI.s XI - Miscellaneous
XI.s - Sniffing death - Death from inhalation of compound XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia XV.as XV - Pathology
XV.as - Path: Fire eater's lung XVI.b XVI - Imaging
XVI.b - Imaging: Ground-glass opacities (GGO) / shadowing XVI.f XVI - Imaging
XVI.f - Imaging: Bibasilar opacities/shadowing XVI.k XVI - Imaging
XVI.k - Imaging: An area or areas of consolidation XVI.ab XVI - Imaging
XVI.ab - Imaging: Cavitating/cavitary lung nodule, mass or nodules (see also Iq, XIs, XIIi, XVIaa and XVIIp) XVI.ah XVI - Imaging
XVI.ah - Imaging: Pneumatoceles (see also XVIaf) XIX.a XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA
XIX.a - BAL: An excess proportion of lymphocytes XIX.h XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA
XIX.h - BAL: Exogenous (oil red O-stainable) lipids in BAL macrophages
I.b - Pneumonitis (ILD) I.g I - Interstitial/parenchymal lung disease
I.g - Pulmonary fibrosis I.j I - Interstitial/parenchymal lung disease
I.j - Exogenous lipoid pneumonia (subacute, acute) I.z I - Interstitial/parenchymal lung disease
I.z - An area or areas of consolidation I.ae I - Interstitial/parenchymal lung disease
I.ae - Hydrocarbon pneumonitis I.af I - Interstitial/parenchymal lung disease
I.af - Chemical (toxic) pneumonitis I.ag I - Interstitial/parenchymal lung disease
I.ag - Fire-eater's lung/pneumonitis II.b II - Pulmonary edema - Acute lung injury - ARDS
II.b - ARDS - Acute lung injury III.a III - Pulmonary/alveolar./airway hemorrhage/bleeding
III.a - Alveolar hemorrhage (AH), diffuse AH (DAH) III.c III - Pulmonary/alveolar./airway hemorrhage/bleeding
III.c - Hemoptysis IV.k IV - Airway involvement
IV.k - Bronchiectasis V.a V - Pleural and/or pericardial involvement
V.a - Pleural effusion (uni- or bilateral) (May commpany ILDs) VIII.d VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.d - Thermal (burns, frostbite), chemical or caustic facial and/or airway injury XI.b XI - Miscellaneous
XI.b - Chest pain (acute or subacute), lone or prominent XI.s XI - Miscellaneous
XI.s - Sniffing death - Death from inhalation of compound XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia XV.as XV - Pathology
XV.as - Path: Fire eater's lung XVI.b XVI - Imaging
XVI.b - Imaging: Ground-glass opacities (GGO) / shadowing XVI.f XVI - Imaging
XVI.f - Imaging: Bibasilar opacities/shadowing XVI.k XVI - Imaging
XVI.k - Imaging: An area or areas of consolidation XVI.ab XVI - Imaging
XVI.ab - Imaging: Cavitating/cavitary lung nodule, mass or nodules (see also Iq, XIs, XIIi, XVIaa and XVIIp) XVI.ah XVI - Imaging
XVI.ah - Imaging: Pneumatoceles (see also XVIaf) XIX.a XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA
XIX.a - BAL: An excess proportion of lymphocytes XIX.h XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA
XIX.h - BAL: Exogenous (oil red O-stainable) lipids in BAL macrophages
2
Ifosfamide
I.b
I - Interstitial/parenchymal lung disease
I.b - Pneumonitis (ILD) I.g I - Interstitial/parenchymal lung disease
I.g - Pulmonary fibrosis I.ad I - Interstitial/parenchymal lung disease
I.ad - Radiation recall pneumonitis II.a II - Pulmonary edema - Acute lung injury - ARDS
II.a - Pulmonary edema, noncardiogenic (NCPE) II.d II - Pulmonary edema - Acute lung injury - ARDS
II.d - Pulmonary edema, cardiogenic XI.a XI - Miscellaneous
XI.a - Cyanosis, a low SpO2 and normal measured PaO2 XII.f XII - Cardiovascular involvement / toxicity
XII.f - Cardiomyopathy (acute, subacute, chronic) XII.l XII - Cardiovascular involvement / toxicity
XII.l - Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP) XII.n XII - Cardiovascular involvement / toxicity
XII.n - Cardiovascular collapse - Cardiogenic shock - Hypotension XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia XV.h XV - Pathology
XV.h - Path: NSIP-fibrotic pattern XV.j XV - Pathology
XV.j - Path: Pulmonary fibrosis (UIP-pattern)
I.b - Pneumonitis (ILD) I.g I - Interstitial/parenchymal lung disease
I.g - Pulmonary fibrosis I.ad I - Interstitial/parenchymal lung disease
I.ad - Radiation recall pneumonitis II.a II - Pulmonary edema - Acute lung injury - ARDS
II.a - Pulmonary edema, noncardiogenic (NCPE) II.d II - Pulmonary edema - Acute lung injury - ARDS
II.d - Pulmonary edema, cardiogenic XI.a XI - Miscellaneous
XI.a - Cyanosis, a low SpO2 and normal measured PaO2 XII.f XII - Cardiovascular involvement / toxicity
XII.f - Cardiomyopathy (acute, subacute, chronic) XII.l XII - Cardiovascular involvement / toxicity
XII.l - Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP) XII.n XII - Cardiovascular involvement / toxicity
XII.n - Cardiovascular collapse - Cardiogenic shock - Hypotension XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia XV.h XV - Pathology
XV.h - Path: NSIP-fibrotic pattern XV.j XV - Pathology
XV.j - Path: Pulmonary fibrosis (UIP-pattern)
1
Inhalants (volatile substances)
I.ao
I - Interstitial/parenchymal lung disease
I.ao - Pulmonary infiltrates II.a II - Pulmonary edema - Acute lung injury - ARDS
II.a - Pulmonary edema, noncardiogenic (NCPE) III.a III - Pulmonary/alveolar./airway hemorrhage/bleeding
III.a - Alveolar hemorrhage (AH), diffuse AH (DAH) V.f V - Pleural and/or pericardial involvement
V.f - Pneumothorax VII.h VII - Mediastinal involvement
VII.h - Pneumomediastinum VIII.a VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.a - Angioedema (may cause UAO, asphyxia and death) VIII.d VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.d - Thermal (burns, frostbite), chemical or caustic facial and/or airway injury XI.a XI - Miscellaneous
XI.a - Cyanosis, a low SpO2 and normal measured PaO2 XI.d XI - Miscellaneous
XI.d - Metabolic acidosis (incl. lactic acidosis/-gap). May cause hyperpnea/dyspnea XI.s XI - Miscellaneous
XI.s - Sniffing death - Death from inhalation of compound XI.aw XI - Miscellaneous
XI.aw - Lead poisoning XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia XV.w XV - Pathology
XV.w - Path: Pulmonary edema (see also II/IIa) XXIV.a XXIV - Veterinary medicine
XXIV.a - Veterinary: Pneumonitis - Interstitial lung disease
I.ao - Pulmonary infiltrates II.a II - Pulmonary edema - Acute lung injury - ARDS
II.a - Pulmonary edema, noncardiogenic (NCPE) III.a III - Pulmonary/alveolar./airway hemorrhage/bleeding
III.a - Alveolar hemorrhage (AH), diffuse AH (DAH) V.f V - Pleural and/or pericardial involvement
V.f - Pneumothorax VII.h VII - Mediastinal involvement
VII.h - Pneumomediastinum VIII.a VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.a - Angioedema (may cause UAO, asphyxia and death) VIII.d VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.d - Thermal (burns, frostbite), chemical or caustic facial and/or airway injury XI.a XI - Miscellaneous
XI.a - Cyanosis, a low SpO2 and normal measured PaO2 XI.d XI - Miscellaneous
XI.d - Metabolic acidosis (incl. lactic acidosis/-gap). May cause hyperpnea/dyspnea XI.s XI - Miscellaneous
XI.s - Sniffing death - Death from inhalation of compound XI.aw XI - Miscellaneous
XI.aw - Lead poisoning XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia XV.w XV - Pathology
XV.w - Path: Pulmonary edema (see also II/IIa) XXIV.a XXIV - Veterinary medicine
XXIV.a - Veterinary: Pneumonitis - Interstitial lung disease
3
Lidocaine (lignocaine, xylocaine)
II.a
II - Pulmonary edema - Acute lung injury - ARDS
II.a - Pulmonary edema, noncardiogenic (NCPE) II.b II - Pulmonary edema - Acute lung injury - ARDS
II.b - ARDS - Acute lung injury II.g II - Pulmonary edema - Acute lung injury - ARDS
II.g - Negative pressure pulmonary edema (NPPE) IV.a IV - Airway involvement
IV.a - Bronchospasm - Wheezing - Asthma IV.f IV - Airway involvement
IV.f - Severe or catastrophic bronchospasm or asthma attack (can be fatal) VIII.a VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.a - Angioedema (may cause UAO, asphyxia and death) VIII.f VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.f - Central airway instability - Tracheomalacia X.f X - Systemic/Distant conditions, syndromes and reactions
X.f - Anaphylaxis-Anaphylactoid reaction (can be fatal) XI.a XI - Miscellaneous
XI.a - Cyanosis, a low SpO2 and normal measured PaO2 XI.r XI - Miscellaneous
XI.r - Death following exposure or poisoning XII.l XII - Cardiovascular involvement / toxicity
XII.l - Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP) XII.m XII - Cardiovascular involvement / toxicity
XII.m - Cardiac- cardiorespiratory/pulmonary arrest XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia
II.a - Pulmonary edema, noncardiogenic (NCPE) II.b II - Pulmonary edema - Acute lung injury - ARDS
II.b - ARDS - Acute lung injury II.g II - Pulmonary edema - Acute lung injury - ARDS
II.g - Negative pressure pulmonary edema (NPPE) IV.a IV - Airway involvement
IV.a - Bronchospasm - Wheezing - Asthma IV.f IV - Airway involvement
IV.f - Severe or catastrophic bronchospasm or asthma attack (can be fatal) VIII.a VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.a - Angioedema (may cause UAO, asphyxia and death) VIII.f VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.f - Central airway instability - Tracheomalacia X.f X - Systemic/Distant conditions, syndromes and reactions
X.f - Anaphylaxis-Anaphylactoid reaction (can be fatal) XI.a XI - Miscellaneous
XI.a - Cyanosis, a low SpO2 and normal measured PaO2 XI.r XI - Miscellaneous
XI.r - Death following exposure or poisoning XII.l XII - Cardiovascular involvement / toxicity
XII.l - Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP) XII.m XII - Cardiovascular involvement / toxicity
XII.m - Cardiac- cardiorespiratory/pulmonary arrest XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia
3
Mephedrone
XI.a
XI - Miscellaneous
XI.a - Cyanosis, a low SpO2 and normal measured PaO2 XI.b XI - Miscellaneous
XI.b - Chest pain (acute or subacute), lone or prominent XII.g XII - Cardiovascular involvement / toxicity
XII.g - Coronary artery disease (acute) - Myocardial ischemia/infarction XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia
XI.a - Cyanosis, a low SpO2 and normal measured PaO2 XI.b XI - Miscellaneous
XI.b - Chest pain (acute or subacute), lone or prominent XII.g XII - Cardiovascular involvement / toxicity
XII.g - Coronary artery disease (acute) - Myocardial ischemia/infarction XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia
1
Methylene blue
II.a
II - Pulmonary edema - Acute lung injury - ARDS
II.a - Pulmonary edema, noncardiogenic (NCPE) X.f X - Systemic/Distant conditions, syndromes and reactions
X.f - Anaphylaxis-Anaphylactoid reaction (can be fatal) XI.d XI - Miscellaneous
XI.d - Metabolic acidosis (incl. lactic acidosis/-gap). May cause hyperpnea/dyspnea XI.f XI - Miscellaneous
XI.f - Bluish, pseudocyanotic skin discoloration XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia
II.a - Pulmonary edema, noncardiogenic (NCPE) X.f X - Systemic/Distant conditions, syndromes and reactions
X.f - Anaphylaxis-Anaphylactoid reaction (can be fatal) XI.d XI - Miscellaneous
XI.d - Metabolic acidosis (incl. lactic acidosis/-gap). May cause hyperpnea/dyspnea XI.f XI - Miscellaneous
XI.f - Bluish, pseudocyanotic skin discoloration XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia
2
Metoclopramide
IV.a
IV - Airway involvement
IV.a - Bronchospasm - Wheezing - Asthma IV.f IV - Airway involvement
IV.f - Severe or catastrophic bronchospasm or asthma attack (can be fatal) IX.b IX - Neuromuscular / CNS involvement - Disordered breathing during sleep
IX.b - Respiratory dyskinesia XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia XIV.b XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.b - Sulfhemoglobinemia
IV.a - Bronchospasm - Wheezing - Asthma IV.f IV - Airway involvement
IV.f - Severe or catastrophic bronchospasm or asthma attack (can be fatal) IX.b IX - Neuromuscular / CNS involvement - Disordered breathing during sleep
IX.b - Respiratory dyskinesia XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia XIV.b XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.b - Sulfhemoglobinemia
1
Naproxen
I.c
I - Interstitial/parenchymal lung disease
I.c - Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia) II.a II - Pulmonary edema - Acute lung injury - ARDS
II.a - Pulmonary edema, noncardiogenic (NCPE) IV.a IV - Airway involvement
IV.a - Bronchospasm - Wheezing - Asthma X.a X - Systemic/Distant conditions, syndromes and reactions
X.a - DRES syndrome - DRESS-like reaction X.f X - Systemic/Distant conditions, syndromes and reactions
X.f - Anaphylaxis-Anaphylactoid reaction (can be fatal) XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia
I.c - Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia) II.a II - Pulmonary edema - Acute lung injury - ARDS
II.a - Pulmonary edema, noncardiogenic (NCPE) IV.a IV - Airway involvement
IV.a - Bronchospasm - Wheezing - Asthma X.a X - Systemic/Distant conditions, syndromes and reactions
X.a - DRES syndrome - DRESS-like reaction X.f X - Systemic/Distant conditions, syndromes and reactions
X.f - Anaphylaxis-Anaphylactoid reaction (can be fatal) XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia
1
Nitric oxide (NO)
II.a
II - Pulmonary edema - Acute lung injury - ARDS
II.a - Pulmonary edema, noncardiogenic (NCPE) II.f II - Pulmonary edema - Acute lung injury - ARDS
II.f - Hypoxemia, low oxygen saturation (may occur in isolation) VI.q VI - Pulmonary vasculopathies
VI.q - Rebound pulmonary arterial hypertension XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia
II.a - Pulmonary edema, noncardiogenic (NCPE) II.f II - Pulmonary edema - Acute lung injury - ARDS
II.f - Hypoxemia, low oxygen saturation (may occur in isolation) VI.q VI - Pulmonary vasculopathies
VI.q - Rebound pulmonary arterial hypertension XIV.a XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)
XIV.a - Methemoglobinemia
2