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J Trauma Inj > Epub ahead of print
DOI: https://doi.org/10.20408/jti.2021.0089    [Epub ahead of print]
Published online December 10, 2021.
Acute Methemoglobinemia after a Blast Injury: A Case Report
Donghoon Kim1,2,3, Yoonhyun Lee2, Sung Yub Jeong2, Hojun Lee2 
1Department of Critical Care Medicine, Armed Forces Capital Hospital, Seongnam, Korea
2Armed Forces Trauma Center, Armed Forces Capital Hospital, Seongnam, Korea
3Division of Cardiology, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
Correspondence:  Hojun Lee, Tel: +82-31-789-2848, Fax: +82-31-706-0987, 
Email: whitegown@hotmail.com
Received: 5 September 2021   • Revised: 29 November 2021   • Accepted: 1 December 2021
Abstract
Methemoglobin is a structurally modified form of hemoglobin incapable of binding oxygen, and elevated levels of methemoglobin cause tissue hypoxia. Occupational exposure to 2,4,6-trinitrotoluene, commonly called trinitrotoluene (TNT), causes methemoglobinemia. This case report describes a 27-year-old male sergeant who developed methemoglobinemia upon exposure to TNT after a blast injury while welding the walls of tank shells. This is the first case of its kind in the Republic of Korea. The patient had multiple burns in his abdomen and open fractures in his right leg. While his body temperature, heart rate, respiratory rate, arterial blood pressure, and chest X-ray were normal, arterial gas analysis revealed acute (methemoglobinemia concentration, 13.5%; oxygen saturation, 92.0%), probably caused by nitroglycerin exposure. Aspiration and adsorption through the skin and respiratory system were suspected to be the routes of entry. His methemoglobinemia normalized after 4 days after treating the wounds surgically, administering oxygen therapy, and performing blood transfusion.
Key Words: Methemoglobinemia; Trinitrotoluene; Blast injuries


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