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When your patient turns blue after you’ve infiltrated lignocaine around their wound…think Methaemoglobinaemia

MetHb level (%)   Signs and symptoms
 1-3% (normal)
  • None
 3-15%
  • Low pulse oximetry (<90%)
  • Gray cutaneous coloration
 15-20%
  • Chocolate brown blood
  • Cyanosis
 20-50%
  • Dizziness, syncope
  • Dyspnea
  • Weakness
  • Headache
 50-70%
  • CNS depression, coma, seizure
  • Dysrhythmias
  • Tachypnea
  • Metabolic acidosis
 >70%
  • Death
  • Hypoxic injury

Emergency Medicine Kenya Foundation

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