====== Problems for Discussion - 3 - Methaemoglobinaemia ======

===== OBJECTIVES =====

  * Understand the mechanisms of methaemoglobinaemia
  * Understand the basis of treatment with methylene blue
  * Understand the issues underlying treatment failure

===== PROBLEM 1 =====

You are working in a rural hospital in Asia. A patient presents following ingestion of a herbicide called Propanil. Propanil is known to cause methaemoglobinaemia. Your patient is very blue and unconscious. You have no pathology.

  - What things would you include in your clinical assessment?
  - You have 100 mg of methylene blue that your mother prophetically packed with your toothpaste and antimalarials. You give this; however, the patient is still blue but wakes and speaks with you (in a language you don’t understand). Then 1 hour later he deteriorates. How would you interpret this sequence of events?
  - You have searched your bag and there are no more blue things. What will you do now?

===== EXERCISE =====

  - What other chemicals, including pharmaceuticals can cause methaemoglobinaemia?
  - Who is particularly at risk of methaemoglobinaemia and why?