Severe Methemoglobinemia Due to Nitrite Intoxication in a Child Who was Misdiagnosed with Sepsis

We present here, a child with an extremely high methemoglobin level caused by inadvertently prepared sodium nitrite and potassium nitrite by a pharmacist. On physical examination, he had tachycardia and tachypnea. He had cyanosis, and mottled and blue-gray skin color. Oxygen saturation was 85% on room air. He was intubated due to seizure and arterial hypotension. Although he had no history of cyanotic heart disease, cyanosis was resistant to 100% oxygen therapy. Venous blood gas sampling revealed metabolic acidosis and methemoglobinemia (86.2%). Methylene blue dye at a dose of 2 mg/kg and ascorbic acid at a dose of 500 mg were administered intravenously and the clinical improvement was observed in 12 hours. Methemoglobinemia can cause severe systemic findings and death. The clinical findings can mimic septic shock. Emergency physicians should have awareness of methemoglobinemia in patients with cyanosis unresponsive to oxygen therapy.