A husband and wife, both emergency room physicians, presented with toxic ingestion of the drug. The year-old husband called EMS after his wife, age 33, developed vomiting and diarrhea, followed by a witnessed seizure. Upon arrival to the hospital, the patients manifested severe cyanosis and were hypotensive and hypoxemic despite high flow oxygen. Methemoglobinemia is a condition in which oxidation of ferrous iron creates an altered state of hemoglobin that is unable to adequately unload oxygen, resulting in tissue hypoxia. The patients received IV methylene blue and hydration, and all symptoms resolved within 6 hours of presentation.
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