Monday, October 17, 2011

Hurricane I

This is the first part of a two-part case.

You are on call covering a whole hospital of medicine patients when you get a call from a nurse that a patient who recently had an upper endoscopy has a sore throat. The patient is a 50 year old African American gentleman with hypertension and alcohol abuse who presented with coffee ground emesis. His EGD was negative. The plan on the sign out is to discharge him the following day. His labs look fine. You decide to write him for benzocaine 20% topical throat spray and his symptoms resolve.

Once the floor quiets down, you go to sleep, and at midnight, the nurse pages you and says the patient now has a headache, fatigue, and lethargy. You figure he's just not sleeping so you give him acetaminophen and zolpidem. You go back to bed.

At 3am, a code blue is called and you rush down to find...this patient. The code blue was called for respiratory depression and hypoxia. You note an oxygen saturation of 86% and the patient is minimally arousable. You go ahead and get an arterial blood gas, shown in the image. The patient's ABG is the tube on the left; a control ABG is on the right.

Challenge: The results of the ABG are pending, but your initial diagnosis is...what?

Image shown under Fair Use.

5 comments:

tree said...

methemoglobinemia

sid said...

Methaemoglobinemia

Anonymous said...

methemoglobinemia 2/2 benzocaine

Irene said...

love this site, craig! I guess methemoglobinemia :)

Craig Chen said...

Yes! I actually got asked this by an attending today! Good thing I looked it up :)
-
Hurricane I

This is methemoglobinemia, and one of the most common acquired causes are topical anesthetics like benzocaine (also called “Hurricane spray”). The blood in an arterial blood gas is described as dark-red, chocolate, or brownish. In methemoglobinemia, the oxygen saturation is close to 85% but the PaO2 is normal.

Sources: UpToDate; www.nejm.org.