title: Methylene blue by intraosseous infusion for methemoglobinemia.
abstract: Intraosseous administration of methylene blue may be an emergency alternative to intravascular administration. A 6-week-old female infant (3 kg) presented to the emergency department after a 1-week illness and appeared cyanotic and listless. Oxygen saturation by oximetry was 86% while the patient was receiving oxygen. Vital signs were blood pressure, 107/80 mm Hg; pulse, 190; respirations, 47; temperature, 39.0 degreesC. A metabolic acidosis and a methemoglobin level of 29.3% were present. After several unsuccessful attempts to establish intravenous access, an intraosseous needle was placed in the infant's left tibia. Methylene blue, 1 mg/kg, normal saline solution, and sodium bicarbonate were given intraosseously. The patient's oxygen saturation rose to 98% to 100%, and her cyanosis improved. Three hours later, her methemoglobin level was 8.2%. The child recovered uneventfully and was sent home after 3 days. Intraosseous administration of standard intravenous doses of methylene blue rapidly terminated the effects of acquired methemoglobinemia.
authors.affiliation: Southern Poison Center, LeBonheur Children's Medical Center, and The University of Tennessee, Memphis 38163, USA.
authors.forename: M I
authors.initials: MI
authors.lastname: Herman
authors.forename: P A
authors.initials: PA
authors.lastname: Chyka
authors.forename: A Y
authors.initials: AY
authors.lastname: Butler
authors.forename: S E
authors.initials: SE
authors.lastname: Rieger
mesh_terms: D000931:Antidotes / Q000008:administration & dosage*; D001842:Bone and Bones; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007267:Injections; D008708:Methemoglobinemia / Q000188:drug therapy*; D008751:Methylene Blue / Q000008:administration & dosage*; D010092:Oximetry
chemical_list: D000931:Antidotes; D008751:Methylene Blue