Ascorbic Acid for Methemoglobinemia Treatment: A Case Report and Literature Review.

Abstract

PURPOSE:

Ascorbic acid has been proposed as an alternative treatment for methemoglobinemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. However, its efficacy has never been compared to that of methylene blue given the inability of patients with G6PD deficiency to receive methylene blue. We present a case of methemoglobinemia treated with ascorbic acid in a patient without G6PD deficiency who had previously received methylene blue.

SUMMARY:

A 66-year-old male was treated for methemoglobinemia deemed to be secondary to benzocaine throat spray. He received intravenous (IV) methylene blue but had a severe reaction: diaphoresis, lightheadedness, and hypotension. The infusion was stopped prior to completion. Approximately 6 days later he presented with methemoglobinemia following an additional overconsumption of benzocaine and was treated with ascorbic acid. In both instances his methemoglobin levels were >30% on arterial blood gas on admission and decreased to 6.5% and 7.8%, respectively, after administration of methylene blue and ascorbic acid.

CONCLUSION:

Ascorbic acid had a similar effect on decreasing the concentration of methemoglobin compared to methylene blue. Further research into use of ascorbic acid as a recommended agent for treatment of methemoglobinemia is warranted.

• Authors: Kelli R Keats, Rachel Robinson, Mallika Patel, Alexis Wallace, Stephanie Albrecht
• Journal: Journal of pharmacy practice (J Pharm Pract) Pg. 8971900231188834 (Jul 08 2023) ISSN: 1531-1937 [Electronic] United States
• PMID: 37421600 (Publication Type: Journal Article)