Knowledge Check 2

“I’ve given 3 doses and Methylene Blue isn’t working….” What should you be considering?

  • Could there be an underlying NADPH-methaemoglobin-reductase or G6PD deficiency?
  • Could there be an underlying HbM haemoglobinopathy?
  • Is this a case of Sulfhaemoglobinaemia?
  • Have I given too much Methylene Blue? At higher doses Methylene Blue has an oxidation effect.
  • Have they taken too much toxin? Does the toxin exposure exceed the power of Methylene Blue, or is there a “double dipping” effect at work (e.g. Dapsone commonly causes a second rise in MetHb after several hours)
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