A Case of Severe Hypoxia Caused by Phenazopyridine-Induced Methemoglobinemia: A near Fatal Event from Over-the-Counter Medication Use
Methemoglobinemia is a rare blood disorder characterized by the oxidation of heme iron from ferrous (Fe<sup>2+</sup>) to ferric (Fe<sup>3+</sup>) state, which increases oxygen affinity and impairs oxygen release to the tissue causing hypoxia. It can be congenital or acquired;...
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MDPI AG
2022-10-01
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| Series: | Clinics and Practice |
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| Online Access: | https://www.mdpi.com/2039-7283/12/6/89 |
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| author | Ojbindra KC Ananta Subedi Rakshya Sharma Punya Hari Dahal Manisha Koirala |
| author_facet | Ojbindra KC Ananta Subedi Rakshya Sharma Punya Hari Dahal Manisha Koirala |
| author_sort | Ojbindra KC |
| collection | DOAJ |
| description | Methemoglobinemia is a rare blood disorder characterized by the oxidation of heme iron from ferrous (Fe<sup>2+</sup>) to ferric (Fe<sup>3+</sup>) state, which increases oxygen affinity and impairs oxygen release to the tissue causing hypoxia. It can be congenital or acquired; however, most cases are acquired and caused by exogenous substances such as medications, chemicals, and environmental substances. Phenazopyridine is an over-the-counter urinary analgesic medication commonly used for symptomatic relief of dysuria and has been reported to cause methemoglobinemia. However, only a handful of cases of phenazopyridine-induced methemoglobinemia have been reported. We present a case of an 89-year-old female who presented with severe hypoxia, shortness of breath, headache, nausea, and dizziness caused by phenazopyridine-induced methemoglobinemia. She was found to have a methemoglobin level of 21.5% and was treated with methylene blue, leading to a rapid improvement of her symptoms. She was taking one over-the-counter phenazopyridine 200 mg tablet three times daily for two weeks for her chronic dysuria. This case highlights the need to have a high index of suspicion of phenazopyridine-induced methemoglobinemia in a patient presenting with unexplained shortness of breath with a history of phenazopyridine use as it could lead to severe methemoglobinemia with hypoxia that could potentially be fatal if not promptly diagnosed. |
| first_indexed | 2024-03-09T17:10:52Z |
| format | Article |
| id | doaj.art-f5f808f6aaae4eae80dd8c88d808e4e1 |
| institution | Directory Open Access Journal |
| issn | 2039-7283 |
| language | English |
| last_indexed | 2024-03-09T17:10:52Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Clinics and Practice |
| spelling | doaj.art-f5f808f6aaae4eae80dd8c88d808e4e12023-11-24T14:05:05ZengMDPI AGClinics and Practice2039-72832022-10-0112684585110.3390/clinpract12060089A Case of Severe Hypoxia Caused by Phenazopyridine-Induced Methemoglobinemia: A near Fatal Event from Over-the-Counter Medication UseOjbindra KC0Ananta Subedi1Rakshya Sharma2Punya Hari Dahal3Manisha Koirala4Department of Hospital Medicine, Faith Regional Health Services, Norfolk, NE 68701, USADepartment of Hospital Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, SD 57105, USADepartment of Hospital Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, SD 57105, USADepartment of Hospital Medicine, Faith Regional Health Services, Norfolk, NE 68701, USADepartment of Hospital Medicine, Faith Regional Health Services, Norfolk, NE 68701, USAMethemoglobinemia is a rare blood disorder characterized by the oxidation of heme iron from ferrous (Fe<sup>2+</sup>) to ferric (Fe<sup>3+</sup>) state, which increases oxygen affinity and impairs oxygen release to the tissue causing hypoxia. It can be congenital or acquired; however, most cases are acquired and caused by exogenous substances such as medications, chemicals, and environmental substances. Phenazopyridine is an over-the-counter urinary analgesic medication commonly used for symptomatic relief of dysuria and has been reported to cause methemoglobinemia. However, only a handful of cases of phenazopyridine-induced methemoglobinemia have been reported. We present a case of an 89-year-old female who presented with severe hypoxia, shortness of breath, headache, nausea, and dizziness caused by phenazopyridine-induced methemoglobinemia. She was found to have a methemoglobin level of 21.5% and was treated with methylene blue, leading to a rapid improvement of her symptoms. She was taking one over-the-counter phenazopyridine 200 mg tablet three times daily for two weeks for her chronic dysuria. This case highlights the need to have a high index of suspicion of phenazopyridine-induced methemoglobinemia in a patient presenting with unexplained shortness of breath with a history of phenazopyridine use as it could lead to severe methemoglobinemia with hypoxia that could potentially be fatal if not promptly diagnosed.https://www.mdpi.com/2039-7283/12/6/89methemoglobinemiahypoxiaphenazopyridineover-the-counter medication |
| spellingShingle | Ojbindra KC Ananta Subedi Rakshya Sharma Punya Hari Dahal Manisha Koirala A Case of Severe Hypoxia Caused by Phenazopyridine-Induced Methemoglobinemia: A near Fatal Event from Over-the-Counter Medication Use Clinics and Practice methemoglobinemia hypoxia phenazopyridine over-the-counter medication |
| title | A Case of Severe Hypoxia Caused by Phenazopyridine-Induced Methemoglobinemia: A near Fatal Event from Over-the-Counter Medication Use |
| title_full | A Case of Severe Hypoxia Caused by Phenazopyridine-Induced Methemoglobinemia: A near Fatal Event from Over-the-Counter Medication Use |
| title_fullStr | A Case of Severe Hypoxia Caused by Phenazopyridine-Induced Methemoglobinemia: A near Fatal Event from Over-the-Counter Medication Use |
| title_full_unstemmed | A Case of Severe Hypoxia Caused by Phenazopyridine-Induced Methemoglobinemia: A near Fatal Event from Over-the-Counter Medication Use |
| title_short | A Case of Severe Hypoxia Caused by Phenazopyridine-Induced Methemoglobinemia: A near Fatal Event from Over-the-Counter Medication Use |
| title_sort | case of severe hypoxia caused by phenazopyridine induced methemoglobinemia a near fatal event from over the counter medication use |
| topic | methemoglobinemia hypoxia phenazopyridine over-the-counter medication |
| url | https://www.mdpi.com/2039-7283/12/6/89 |
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