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A Case Report and Review of Sulfhemoglobinemia

Howard C. Lu, MD; Richard D. Shih, MD; Steven Marcus, MD; Bruce Ruck, PharmD; Thelma Jennis

Arch Pediatr Adolesc Med. 1998;152:803-805.

Objectives  To see if methemoglobin could potentially be misdiagnosed and the limitation of present co-oximeters.

Patient  A 17-year-old girl who overingested a combination of cimetidine, acetaminophen, ibuprofen, and naproxen in a suicide attempt.

Method  Use of pulse co-oximeters to aid in the diagnosis of suspected sulfhemoglobinemia.

Results  Diagnosis of sulfhemoglobinemia achieved with final confirmation made with gas chromatography. Patient steadily improved with supportive care.

Conclusions  There is a potential for the diagnosis of methemoglobin with some of the limitations of present co-oximeters. The laboratory diagnosis of sulfhemoglobinemia can be difficult to make.

From the Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, NJ (Drs Lu and Shih); and the New Jersey Poison Information and Education System (Drs Shih, Marcus, and Ruck and Ms Jennis) and the Department of Pediatrics (Dr Marcus), Newark Beth Israel Medical Center, Newark, NJ.