How is methemoglobinemia treated in smoke inhalation injury?

Updated: Oct 15, 2021
  • Author: Keith A Lafferty, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Methemoglobinemia in smoke inhalation is relatively rare and rarely requires treatment with methylene blue. This antidote is reduced by the nicotinamide adenine dinucleotide phosphate (NADPH) methemoglobin reductase enzyme and, in return, reduces methemoglobin to hemoglobin. Indications for treatment with methylene blue as follows:

  • Alteration in mental status

  • Acidosis

  • Electrocardiographic (ECG) changes

  • Ischemic chest pain

Methemoglobin levels lower than 30% may not require treatment, depending on the patient's cardiorespiratory reserve.

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