Refractory hypoxia and saturation gap in a COVID-19 patient
Acquired methemoglobinemia, predominantly due to oxidizing medications occurs when heme iron in hemoglobin is oxidized from ferrous to ferric ion and binds oxygen irreversibly leading to functional anemia, cyanosis, and tissue hypoxia. We report a case of a 60-year-old man with multiple comorbiditie...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024
|
| Online Access: | http://psasir.upm.edu.my/id/eprint/112911/ http://psasir.upm.edu.my/id/eprint/112911/1/112911.pdf |
| _version_ | 1848866074138771456 |
|---|---|
| author | Mobarak, Abidah C. Thambiah, Subashini Masiman, Ana Daliela Samsudin, Intan Nureslyna Lai, Yin Ye |
| author_facet | Mobarak, Abidah C. Thambiah, Subashini Masiman, Ana Daliela Samsudin, Intan Nureslyna Lai, Yin Ye |
| author_sort | Mobarak, Abidah |
| building | UPM Institutional Repository |
| collection | Online Access |
| description | Acquired methemoglobinemia, predominantly due to oxidizing medications occurs when heme iron in hemoglobin is oxidized from ferrous to ferric ion and binds oxygen irreversibly leading to functional anemia, cyanosis, and tissue hypoxia. We report a case of a 60-year-old man with multiple comorbidities who was diagnosed with coronavirus disease 2019 (COVID-19) and developed methemoglobinemia after consumption of prescribed supplements. He presented with dyspnea and cyanosis. An oxygen saturation gap with characteristic chocolate-brown arterial blood indicated methemoglobinemia. Outsourced methemoglobin (MetHb) was increased at 9.0%. Despite aggressive intervention, he succumbed to his illness. In this case, we discuss the pathophysiology of why some individuals, especially the elderly with COVID-19 are more susceptible to develop methemoglobinemia after possibly being exposed to oxidizing agents. Laboratory methods for assessing oxygen saturation, including pulse oximetry, arterial blood gas and co-oximetry are examined in relation to this case. The importance of considering a diagnosis of methemoglobinemia based on clinical and biochemical findings although MetHb assay or co-oximetry are not readily available is also emphasized. © 2024 The Authors |
| first_indexed | 2025-11-15T14:14:49Z |
| format | Article |
| id | upm-112911 |
| institution | Universiti Putra Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-15T14:14:49Z |
| publishDate | 2024 |
| publisher | Elsevier |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | upm-1129112024-10-28T07:43:21Z http://psasir.upm.edu.my/id/eprint/112911/ Refractory hypoxia and saturation gap in a COVID-19 patient Mobarak, Abidah C. Thambiah, Subashini Masiman, Ana Daliela Samsudin, Intan Nureslyna Lai, Yin Ye Acquired methemoglobinemia, predominantly due to oxidizing medications occurs when heme iron in hemoglobin is oxidized from ferrous to ferric ion and binds oxygen irreversibly leading to functional anemia, cyanosis, and tissue hypoxia. We report a case of a 60-year-old man with multiple comorbidities who was diagnosed with coronavirus disease 2019 (COVID-19) and developed methemoglobinemia after consumption of prescribed supplements. He presented with dyspnea and cyanosis. An oxygen saturation gap with characteristic chocolate-brown arterial blood indicated methemoglobinemia. Outsourced methemoglobin (MetHb) was increased at 9.0%. Despite aggressive intervention, he succumbed to his illness. In this case, we discuss the pathophysiology of why some individuals, especially the elderly with COVID-19 are more susceptible to develop methemoglobinemia after possibly being exposed to oxidizing agents. Laboratory methods for assessing oxygen saturation, including pulse oximetry, arterial blood gas and co-oximetry are examined in relation to this case. The importance of considering a diagnosis of methemoglobinemia based on clinical and biochemical findings although MetHb assay or co-oximetry are not readily available is also emphasized. © 2024 The Authors Elsevier 2024 Article PeerReviewed text en cc_by_4 http://psasir.upm.edu.my/id/eprint/112911/1/112911.pdf Mobarak, Abidah and C. Thambiah, Subashini and Masiman, Ana Daliela and Samsudin, Intan Nureslyna and Lai, Yin Ye (2024) Refractory hypoxia and saturation gap in a COVID-19 patient. Practical Laboratory Medicine, 40. art. no. e00395. e00395. ISSN 2352-5517 https://www.sciencedirect.com/science/article/pii/S2352551724000416?via%3Dihub 10.1016/j.plabm.2024.e00395 |
| spellingShingle | Mobarak, Abidah C. Thambiah, Subashini Masiman, Ana Daliela Samsudin, Intan Nureslyna Lai, Yin Ye Refractory hypoxia and saturation gap in a COVID-19 patient |
| title | Refractory hypoxia and saturation gap in a COVID-19 patient |
| title_full | Refractory hypoxia and saturation gap in a COVID-19 patient |
| title_fullStr | Refractory hypoxia and saturation gap in a COVID-19 patient |
| title_full_unstemmed | Refractory hypoxia and saturation gap in a COVID-19 patient |
| title_short | Refractory hypoxia and saturation gap in a COVID-19 patient |
| title_sort | refractory hypoxia and saturation gap in a covid-19 patient |
| url | http://psasir.upm.edu.my/id/eprint/112911/ http://psasir.upm.edu.my/id/eprint/112911/ http://psasir.upm.edu.my/id/eprint/112911/ http://psasir.upm.edu.my/id/eprint/112911/1/112911.pdf |