title: 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.affiliation: Department of Emergency Medicine, Pediatric Pulmonary Division, University of Louisville, Louisville, KY. jslhnl@bluegrass.net
authors.forename: J S
authors.initials: JS
authors.lastname: Langford
authors.forename: S
authors.initials: S
authors.lastname: Sheikh
mesh_terms: D000082:Acetaminophen / Q000633:toxicity; D000111:Acetylcysteine / Q000627:therapeutic use*; D000293:Adolescent; D000932:Antiemetics / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008787:Metoclopramide / Q000009:adverse effects*; D011041:Poisoning / Q000188:drug therapy; D013436:Sulfhemoglobinemia / Q000139:chemically induced*
chemical_list: D000932:Antiemetics; D000082:Acetaminophen; D008787:Metoclopramide; D000111:Acetylcysteine