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- Chemical Treatment Guide: GRAY

Chemical Treatment Guide: GRAY

• Dinitrobenzene (DNB)
• Nitrogen products and other products causing methemoglobinemia

SIGNS AND SYMPTOMS

Methemoglobinemia characterized by chocolate-brown-colored blood, CNS depression, headache,
dizziness, ataxia, vertigo, tinnitus, dyspnea, tachypnea, violent coughing, choking, possibly upper
airway obstruction spasm or edema of the glottis, abdominal pain, hypotension, heart blocks,
ventricular dysrhythmias, seizures (rare), pallor, cyanosis, and cardiovascular collapse.
Symptoms may be immediate or may be delayed for 5 to 72 hours.

Supportive Care

• Remove the patient from the hazardous area.
• If the patient was exposed externally, remove his/her clothing and decontaminate as appropriate.
• Administer high-flow oxygen (100%).
• Contact the Poison Information Center (1-800-222-1222).
• If nitrogen product ingestion occurred, adult and pediatric dose administer activated charcoal
1g/kg maximum dose is 50 g PO.

TREATMENT

• Adult and pediatric if the patient is dyspneic, is cyanotic , has normal SpO2 and has chocolate
brown colored blood, administer methylene blue (1%) 1 - 2 mg/kg slow IV over 5 minutes,
followed by a normal saline 30 mL flush to decrease pain at the IV site.
• If the patient has dysrhythmias, treat PRN with appropriate cardiac protocol.
• If seizures continue for 3 minutes, Administer benzodiazepines:
- Midazolam (Versed) Adult dose 2 mg increments IV, IO, IM, or IN,
Pediatric dose 0.1mg/kg, maximum single dose 4 mg IV, IO, IM. For IN administration use 0.2
mg/kg/dose (use 10 mg/2mL concentration), maximum single dose 5 mg; may repeat once
if necessary. Maximum total dose of 10 mg (b)
• If hypotension persists, administer 20 mL/kg normal saline IV PRN (maximum total dose is
60 mL/kg) Neonate 10mg/kg maximum dose is 30mL/kg.
• Do not induce vomiting.
• If cyanosis persists, adult and pediatric dose administer methylene blue (1%) 1-2 mg/kg slow
IV over 5 minutes, followed by a 30 mL flush of normal saline to decrease pain at the IV site.

PEARL
- If risk of exposure from fumes is high, call for a hazardous materials team. Refer to the appropriate
hazardous materials PPE protocol, as the risk of secondary contamination is very high.
- For IN administration, administer, 1ml per nare, give half the volume in one nostril and the other half of the volume in the other nare

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