A Case of Methemoglobinemia and Hemolysis from Sodium Chlorite Ingestion
Bibliographic record
Abstract
Sodium chlorite is a household and industrial cleaning agent that can cause oxidative stress leading to methemoglobinemia and severe hemolysis when ingested.There is a scarcity of published literature reporting this in humans.We report a case of intentional sodium chlorite ingestion for homeopathic purposes that resulted in methemoglobinemia and hemolysis, requiring admission to the intensive care unit.Following successful treatment with methylene blue, the patient developed worsening hemolytic activity.Outpatient testing later revealed she was non-glucose-6-phosphate dehydrogenase (G6PD) deficient.Hemolysis precipitated by methylene blue is an underrecognized side effect that can be observed in individuals both with and without G6PD deficiency.S odium chlorite is an inorganic salt that acts as an oxidizing agent; it is typically used as a household detergent or in an industrial setting to clean drinking water.While sodium chlorite ingestion is known to cause methemoglobinemia, there is a scarcity of published literature reporting this in humans.[1][2][3][4][5][6] Methylene blue is used as an antidote to methemoglobinemia; however, as an oxidizing agent, methylene blue can paradoxically precipitate methemoglobinemia or induce hemolysis in high doses or when methemoglobin is ineffectively reduced.While hemolysis following methylene blue administration is classically seen in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency due to decreased endogenous levels of nicotinamide adenine dinucleotide phosphate (NADPH), 7 this may also be observed in non-G6PD deficient individuals.Here, we report a case of intentional sodium chlorite ingestion for homeopathic purposes resulting in methemoglobinemia and hemolysis that was treated with the administration of methylene blue, resulting in worsening hemolysis in a non-G6PD deficient individual. Case PresentationA woman, aged 60 years, presented to the emergency department with gastrointestinal upset after ingesting two tablespoons of sodium chlorite and citric acid for homeopathic purposes at approximately 0200 hours.She reported taking three drops of this solution daily for several months but accidentally ingested 50 mL of the sodium chlorite solution prior to presentation.She was also taking the following prescribed medications at the time of ingestion: escitalopram 20 mg, mirtazapine 30 mg, trazodone 50 mg as needed, and valacyclovir 500 mg twice daily as needed.Poison Control had been called enroute to the Emergency Department by the patient and her family member.She was hypoxic at presentation, with oxygen saturation below 80% on room air, and she was placed on high-flow nasal cannula and Ventimask with a FiO2 of 100%.A venous blood gas was drawn at 0304
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.007 | 0.005 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".