Methemoglobin
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Methemoglobin (British English: Methaemoglobin) (pronounced "MET-hemoglobin") is a form of the oxygen-carrying protein hemoglobin (British English: haemoglobin), in which the iron in the heme group is in the Fe3+ state, not the Fe2+ of normal hemoglobin. Methemoglobin is unable to carry oxygen. It is chocolate-brown in color. The NADH-dependent enzyme methemoglobin reductase (diaphorase I) is responsible for converting methemoglobin back to hemoglobin.
Normally one to two percent of people's hemoglobin is methemoglobin; a higher percentage than this can be genetic or caused by exposure to various chemicals and depending on the level can cause health problems known as Methemoglobinemia. A higher level of methemoglobin will tend to cause a pulse oximeter to read closer to 85% regardless of the true level of oxygen saturation.[1]
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[edit] Common causes
- Reduced cellular defense mechanisms
- Children younger than 4 months exposed to various environmental agents
- Methemoglobin reductase deficiency
- G6PD deficiency
- Hemoglobin M disease
- Pyruvate kinase deficiency
- Various pharmaceutical compounds
- Local anaesthetic agents, especially prilocaine as used in the Bier block
- Amyl nitrite, chloroquine, dapsone, nitrates, nitrites, nitroglycerin, nitroprusside, phenacetin, phenazopyridine, primaquine, quinones and sulfonamides
- Environmental agents
[edit] Methemoglobin Saturation
Methemoglobin saturation is expressed as the percentage of hemoglobin in the methemoglobin state; That is MetHb as a proportion of Hb.
- 1-2% Normal
- Less than 10% metHb - No symptoms
- 10-20% metHb - Skin discoloration only (most notably on mucus membranes)
- 20-30% metHb - Anxiety, headache, dyspnea on exertion
- 30-50% metHb - Fatigue, confusion, dizziness, tachypnea, palpitations
- 50-70% metHb - Coma, seizures, arrhythmias, acidosis
- Greater than 70% metHb - Death
