Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
New or follow-up for methemoglobinemia
(Specify) Chocolate-colored blood (cyanosis), shortness of breath, headache, confusion (depending on severity)
History of Present Illness:
Onset, duration, and severity of symptoms.
Potential exposure to oxidizing agents:
Medications (dapsone, nitrites, certain antibiotics)
Industrial chemicals (aniline dyes, nitrates)
Recreational drugs (certain inhalants)
History of underlying conditions that may increase susceptibility (e.g., congenital methemoglobinemia, G6PD deficiency)
Past Medical History:
Underlying medical conditions relevant to methemoglobinemia (e.g., G6PD deficiency, congenital methemoglobinemia).
Medications the patient is currently taking.
Medications:
List all current medications, including any medications suspected to be the cause.
Social History:
Occupational exposures to potential oxidizing agents.
Use of recreational drugs (may be a risk factor).
Family History:
Family history of congenital methemoglobinemia (less common).
Physical Exam:
Vital signs: Assess for tachypnea (rapid breathing), hypoxemia (low oxygen levels), and tachycardia (rapid heart rate) in severe cases.
General examination: Assess for cyanosis (bluish discoloration of skin and mucous membranes), confusion, and altered mental status (in severe cases).
Laboratory Tests:
Arterial blood gas (ABG): May show hypoxia (low blood oxygen) despite adequate ventilation.
Methemoglobin level: The definitive test for methemoglobinemia, quantifies the percentage of hemoglobin carrying ferric iron (methemoglobin) which cannot carry oxygen.
Co-oximetry: May be used to differentiate methemoglobinemia from other causes of cyanosis.
Assessment:
Methemoglobinemia: Based on clinical presentation, potential exposure to oxidizing agents, and methemoglobin level.
Severity of methemoglobinemia: Evaluate the severity based on symptoms, methemoglobin level, and oxygen saturation. Mild cases may be asymptomatic, while severe cases can lead to life-threatening hypoxia.
Plan:
Treatment depends on the severity of methemoglobinemia:
Mild cases (methemoglobin < 30%): May require only monitoring with repeat methemoglobin levels.
Moderate cases (methemoglobin 30-50%): Consider administration of methylene blue, an antidote that converts methemoglobin back to hemoglobin.
Severe cases (methemoglobin > 50% or with significant hypoxia): Urgent treatment with methylene blue is necessary, potentially requiring administration in an intensive care unit (ICU) setting.
Supportive care: Oxygen therapy may be needed to improve oxygen delivery to tissues.
Identification and removal of the causative agent: If possible, identify and discontinue any medications or remove exposure to industrial chemicals that may have caused methemoglobinemia.
Consultations:
Depending on the severity, consultations with specialists in toxicology or critical care medicine may be necessary.
Follow-up:
Repeat methemoglobin levels to monitor response to treatment.
Address the underlying cause of methemoglobinemia to prevent recurrence.
Provide education on avoiding future exposure to oxidizing agents.
Disclaimer: This template is for informational purposes only and should be adapted to the specific needs of each patient. Methemoglobinemia can be a life-threatening condition. Early diagnosis and prompt treatment are crucial to prevent complications.