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 sulfhemoglobinemia 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 University of Louisville, Louisville, KY. USA.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Langferd
authors.affiliation: Pediatric Pulmonary Division, Department of Pediatrics, University of Louisville, Louisville, KY. USA.
authors.forename: Shahid
authors.initials: S
authors.lastname: Sheikh