Methemoglobinemia Precipitated Possibly by Three Prescribed Drugs

Methemoglobinemia is a potentially fatal condition, can be congenital but mainly acquired after intoxication by certain drugs. To this date there are very few cases associated with use of multiple drugs leading to methemoglobinemia. We report a patient who developed methemoglobinemia secondary to multiple drugs. Our patient had diabetes related micro and macro vascular complication along with non-vascular complication i.e. diabetic gastropares is along with UTI. She was treated with multiple drugs which included metoclopramide, nitrates, paracetamol which led to methemoglobinemia. All three of these drugs can precipitate methemoglobinemia either individually or in combination with each other. This patient was successfully treated with iv methylene blue.