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. 2021 May 10;362(2):222–224. doi: 10.1016/j.amjms.2021.04.020

TABLE 1.

Descriptive analysis of reported cases of methemoglobinemia in patients with COVID-19.

Age/Sex Peak Meth Hb level Medications for COVID-19 pneumonia Treatment for methemoglobinemia Hospital course Outcome
Naymagon et al.3 50/Male 10.6% Hydroxychloroquine, Azithromycin, Ceftriaxone Methylene blue Ascorbic acid Patient required intensive care, was intubated and required vasopressors MethHb levels normalized by Day 11 of hospitalization, patient got extubated, was still hospitalized
Naymagon et al.3 52/M >30% Hydroxychloroquine, Azithromycin, Cefepime, Cancomycin Methylene blue Ascorbic acid Red cell exchange Patient required intensive care, was intubated, required vasopressors, developed ARF mandating renal replacement therapy Improved clinically with a complete normalization of Met‐Hb level. Patient remains critically ill, ventilated and on vasopressors (Still hospitalized at the time of write up of case)
Naymagon et al.3 54/M 18.8% Hydroxychloroquine, Azithromycin Methylene blue Patient's laboratory suggested worsening hemolysis once started on methylene blue. Patient's Met‐Hb worsened from 13.6% to 18.8%. A new diagnosis of G6PD deficiency was found concurrent to methemoglobinemia. Direct antiglobulin test was negative. The patient died shortly after admission.
Faisal et al.8 74/M 15.9% Azithromycin, Hydroxychloroquine, Lopinavir-ritonavir, Ribavirin, Tocilizumab Intravenous hydroxocobalamin Methylene blue Ascorbic acid Red cell exchange Patient required prolonged intensive care (4 weeks), was intubated, developed ARF requiring renal replacement therapy After prolonged ICU course, patient recovered, got extubated, RRT frequency went down and was discharged to rehabilitation.
Palmer et al.5 62/M 6.5% Amoxicillin/clavulanic acid, Folic acid None Patient required high flow oxygen and renal replacement therapy. Direct antiglobulin test was negative G6DP assay confirmed G6DP deficiency Prolonged duration of stay, was discharged after 22 days of hospital stay.
Lim et al.6 39/M 14.8% Hydroxychloroquine Ascorbic acid Red cell exchange Patient required high flow oxygen and renal replacement therapy G6DP assay confirmed G6DP deficiency Improved, discharged home
Choo et al.4 52/M 30% Hydroxychloroquine, Azithromycin Methylene blue Ascorbic acid Red cell exchange Patient required intensive care, was intubated, required vasopressors, renal replacement therapy. There was a rapid fall in hemoglobin requiring 12 units of PRBCs support Hemolysis resolved; methemoglobin levels improved. The patient was on vasopressors at the time writing up of case.
Kuipers et al.7 56/M 9.1 Hydroxychloroquine Ascorbic acid Patient required intensive care, was intubated. G6DP assay confirmed G6DP deficiency. There was a rapid fall in hemoglobin requiring 3 units of PRBCs support Improved, discharged home