Rebound methaemoglobinaemia secondary to intentional sodium nitrite ingestion

Abstract

SummaryWe report a case of rebounding severe methaemoglobinaemia secondary to sodium nitrite ingestion, despite several administrations of methylene blue. The patient's clinical course was characterised by a series of alternating improvements and deteriorations and proved challenging for treating clinicians. On discussion with poisoning experts, it was hypothesised that a small amount of sodium nitrite remained in the gastrointestinal tract leading to prolonged absorption of the causative agent. Methaemoglobin levels returned to normal following the administration of multi‐dose activated charcoal via a nasogastric tube 30 h after the initial presentation to hospital.