Sulfhemoglobinemia

Background

  • Occurs when a sulfer atom binds to porphyrin ring of hemoglobin, resulting in permanent oxidation of iron to the ferric state, incapable of oxygen transport
  • Most often associated with phenazopyridine, dapsone, metoclopramide, sumatriptan
  • Also associated with industrial chemicals, including trinitrotoluene, hydroxyl amine sulfate, dimethyl sulfoxide, Hydrogen Sulfide

Clinical Features

  • Similar to that of methemoglobinemia
  • Cyanosis, anxiety, headache, weakness, lightheadedness, tachycardia, MI, AMS, seizure

Differential Diagnosis

Evaluation

  • Standard pulse ox tends to report falsely low value
  • ABG, Co-oximetry
  • Dark greenish-black blood

Management

Disposition

See Also

External Links

References

  • Tintinalli's Emergency Medicine 7th Edition, pg 1329-30