Methemoglobinemia Following Monolinuron Ingestion

Guillaume Mortamet (1) , Mehdi Oualha (2) , Sylvain Renolleau (3) , Christian Moesch (4, 5) , Jean-Marc Tréluyer (6, 2, 7, 8, 9)

1 CHU - Centre Hospitalier Universitaire [Grenoble]
2 CHU Necker - Enfants Malades [AP-HP]
3 Service d'Anesthésie Réanimation [CHU Necker]
4 Service de Pharmacologie, toxicologie et pharmacovigilance [CHU Limoges]
5 NET - Neuroépidémiologie Tropicale
6 Hôpital Cochin [AP-HP]
7 UPD5 - Université Paris Descartes - Paris 5
8 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
9 EA_7323 - Evaluation thérapeutique et pharmacologie périnatale et pédiatrique

We describe a case report of a 2-year-old boy presenting to the emergency department with cyanosis and agitation. There was no suggestive history of poisoning but parents reported the presence of an aquarium at the family dinner the night before, with an aquarium cleaner beside it. Physical examination at admission revealed central cyanosis without signs of respiratory distress. Oxygen saturation measured by pulse oximetry (SpO2) was at 80% in room air. Plasma level of methemoglobin was measured at 11.8%. After 6 hours, methemoglobin decreased spontaneously to 5% and pulse oximetry saturation reached 98% in room air. Consciousness, weakness, and behavior were concomitantly improved. Because of rapid and spontaneous improvement, no specific treatment such as methylene blue was administered. A mass spectrometry toxicological analysis was performed in a blood sample taken the day of admission. Screening procedure of pesticides based on liquid chromatography coupled with mass spectrometry identified monolinuron, a phenylurea herbicide.

Domaines: Santé publique et épidémiologie

Guillaume Mortamet, Mehdi Oualha, Sylvain Renolleau, Christian Moesch, Jean-Marc Tréluyer. Methemoglobinemia Following Monolinuron Ingestion. Pediatric Emergency Care, 2018, 34 (3), pp.1. ⟨10.1097/PEC.0000000000000745⟩. ⟨hal-01989765⟩