An adolescent case of sulfhemoglobinemia associated with high-dose metoclopramide and N-acetylcysteine.

Abstract

We describe the case of an adolescent girl who received high-dose metoclopramide in combination with oral N-acetylcysteine therapy for acute acetaminophen toxicity. Whole blood-sample analysis for abnormal hemoglobin pigments established the diagnosis of sulfhemoglobinemia. Metoclopramide has been shown to cause sulfhemoglobinemia, particularly when used in repeated high doses. Although N-acetylcysteine alone has not been associated as the cause, we suggest that sulfhemoglobine-mia is a potential complication in patients treated with metoclopramide for the nausea that often accompanies oral N-acetylcysteine therapy for acetaminophen toxicity. Cyanosis without respiratory distress should suggest this diagnosis.

• Authors: J S Langford, S Sheikh
• Journal: Annals of emergency medicine (Ann Emerg Med) Vol. 34 Issue 4 Pt 1 Pg. 538-41 (Oct 1999) ISSN: 0196-0644 [Print] United States
• PMID: 10499955 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antiemetics
• Acetaminophen
• Metoclopramide
• Acetylcysteine

Topics

• Acetaminophen (toxicity)
• Acetylcysteine (therapeutic use)
• Adolescent
• Antiemetics (adverse effects)
• Female
• Humans
• Metoclopramide (adverse effects)
• Poisoning (drug therapy)
• Sulfhemoglobinemia (chemically induced)