title: Life-threatening methemoglobinemia after unintentional ingestion of antifreeze admixtures containing sodium nitrite in the construction sites.
abstract: BACKGROUND
  Construction workers are exposed to a wide variety of health hazards such as poisoning at the construction sites. Various forms of poisoning incidents in construction workers have been reported. However, studies on methemoglobinemia caused by unintentional ingestion of antifreeze admixtures containing sodium nitrite at the construction sites have not been reported yet.
  
  
  OBJECTIVE
  The aim of this study was to evaluate life-threatening methemoglobinemia after unintentional ingestion of antifreeze admixtures containing sodium nitrite at the construction sites and describe similar incidents involving ingestion of antifreeze admixtures in Korea.
  
  
  METHODS
  Retrospective observational case series study on patients with methemoglobinemia after unintentional ingestion of antifreeze admixtures containing sodium nitrite admitted to the emergency department (ED) from January 1, 2010 to December 31, 2012 and cases reported to the Korea Occupational Safety and Health Agency (KOSHA) was performed. Results. Six victims were admitted to our ED. They had methemoglobin levels ranging from 32.4% to 71.5% and all of them recovered after receiving one (2 mg/kg) or two doses infusion of methylene blue. From the data of the KOSHA, six incidents that caused 27 victims were identified. Of 27 victims, five were included in the ED cases. For all incidents, antifreeze admixtures were not contained in their original containers and all new containers did not have a new label. All workers mistook antifreeze admixtures for water. Among the 28 victims included in this study, four died.
  
  
  CONCLUSIONS
  Unintentional ingestion of antifreeze admixtures containing sodium nitrite at the construction sites can cause life-threatening methemoglobinemia. There is a need to store and label potentially hazardous materials properly to avoid unintentional ingestion at the construction sites.
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center , Seoul , Republic of Korea.
authors.forename: C H
authors.initials: CH
authors.lastname: Sohn
authors.forename: D W
authors.initials: DW
authors.lastname: Seo
authors.forename: S M
authors.initials: SM
authors.lastname: Ryoo
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: W Y
authors.initials: WY
authors.lastname: Kim
authors.forename: K S
authors.initials: KS
authors.lastname: Lim
authors.forename: B J
authors.initials: BJ
authors.lastname: Oh
mesh_terms: D000059:Accidents; D000368:Aged; D000931:Antidotes / Q000627:therapeutic use; D060389:Construction Industry; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008708:Methemoglobinemia / Q000139:chemically induced*; D008751:Methylene Blue / Q000627:therapeutic use; D008875:Middle Aged; D016273:Occupational Exposure; D011092:Polyethylene Glycols / Q000506:poisoning*; D056910:Republic of Korea; D012189:Retrospective Studies; D012977:Sodium Nitrite / Q000506:poisoning*; D016896:Treatment Outcome
chemical_list: D000931:Antidotes; D011092:Polyethylene Glycols; D012977:Sodium Nitrite; D008751:Methylene Blue