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Author: Raja Azhar Iqbal, Urooj Mustafa, Emily Potter, Alexandra Williams / Editor: Jessie Lynch / Codes: PhC2, PhC5, PhP3, SLO3Published: 10/04/2024

A 26-year-old lady presents in the Emergency Department (ED) with a 4-5 hour history of cyanosis, headache, dizziness and nausea. She reports no cough or shortness of breath, and has not taken her temperature but has had no rigors or chills. She states that she hasn’t used any illicit drug.

Fig.1 Image courtesy of the patient

She has a history of obesity and Hidradenitis Suppurativa, for which she takes dapsone 75 mg OD & adalimumamb S/C 40 mg weekly.

Her observations are as follows:

  • Respiratory rate 18 breaths/minute
  • Oxygen saturations 80%
  • Blood pressure 138/87mmHg
  • Temperature 36.4 degrees
  • Heart rate 132 beats/minute

The patient`s blood appears brown/chocolate-coloured (see Fig.1). ABG on 15 litres of oxygen:

pH = 7.41
PO2 = 32.1
PCO2 = 2.75
MetHb = 28.9%
Lactate = 1.58
COHB= 2%