High-Flow Oxygen
All patients warrant supplemental oxygen. Symptoms may improve with a non-rebreather but the pulse oximeter reading will remain unchanged and patients may remain cyanotic. This is a diagnostic clue.<unk> lene blue
Treat if symptomatic OR asymptomatic with<unk>  >25%
1-2mg/kg<unk> lene blue IV over 5min; repeat dose if no effect
Improvement seen within 20min
Contraindicated in G6PD deficiency
May induce acute hemolytic anemia
Instead use moderate dose of ascorbic acid (vitamin C),  300 to 1000 mg/day orally in divided doses
Other treatment modalities
Exchange transfusion for symptomatic<unk>  in patient with G6PD deficiency
Hyperbaric O2 when<unk> lene blue ineffective or contraindicated
IV hydration and bicarbonate for<unk> olic acidosis
All patients warrant supplemental oxygen. Symptoms may improve with a non-rebreather but the pulse oximeter reading will remain unchanged and patients may remain cyanotic. This is a diagnostic clue.
Treat if symptomatic OR asymptomatic with<unk>  >25%
1-2mg/kg<unk> lene blue IV over 5min; repeat dose if no effect
Improvement seen within 20min
Contraindicated in G6PD deficiency
May induce acute hemolytic anemia
Instead use moderate dose of ascorbic acid (vitamin C),  300 to 1000 mg/day orally in divided doses
May induce acute hemolytic anemia
Instead use moderate dose of ascorbic acid (vitamin C),  300 to 1000 mg/day orally in divided doses
Exchange transfusion for symptomatic<unk>  in patient with G6PD deficiency
Hyperbaric O2 when<unk> lene blue ineffective or contraindicated
IV hydration and bicarbonate for<unk> olic acidosis
Methemoglobinemia
Consider rare entity of sulfhemoglobinemia
Sulfhemoglobinemia
Sulfonamides, sulfasalazine, phenazopyridine
Dyshemoglobinemia
Occupational exposure
Hypoxemia
Conventional co-oximerty misidentifies sulfhemoglobin as methemoglobin so diagnosis is suspected when patient does not respond to methylene blue