Indian Journal of Critical Care Case Report

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VOLUME 3 , ISSUE 1 ( January-February, 2024 ) > List of Articles


Methemoglobinemia in a Patient on Maintenance Hemodialysis: A Case Report

Ruchi Gupta, Sumit Ray

Keywords : Acquired methemoglobinemia, Amine filtration, Carbon filters, Case report, Dialysate filtration process, Filtration, Hemodialysis

Citation Information : Gupta R, Ray S. Methemoglobinemia in a Patient on Maintenance Hemodialysis: A Case Report. 2024; 3 (1):18-20.

DOI: 10.5005/jp-journals-11006-0084

License: CC BY-NC 4.0

Published Online: 30-12-2023

Copyright Statement:  Copyright © 2024; The Author(s).


In recent years, India has faced an increasing number of patients requiring dialysis with the insurgence of dedicated dialysis centers. Maintenance hemodialysis presents a unique but undermined potential source of exposure to patients whereby an individual is exposed to around 300–400 L of external water as dialysate fluid. The solutes in water used, along with disinfectants like chlorine, chloramines, amines, and nitrates if not filtered appropriately and used as dialysate may cause methemoglobinemia and other complications in patients undergoing dialysis. Acquired methemoglobinemia though a rare clinical condition, in its severest form, may lead to rapid clinical deterioration and death if not identified and managed in time. The oxidized form of iron in the methemoglobin impedes its binding to the oxygen molecule leading to a drop in oxygen-carrying capacity of the blood. The first step of management is to stop the inciting agent. In a chronic kidney disease (CKD), patient excretion of inciting agent may be impeded in case of renally excreted molecules leading to prolonged exposure and persisting methemoglobinemia. We report this rare case of severe methemoglobinemia in a patient with CKD on dialysis.

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