)
HOSPITAL COURSE:
The patient was admitted for monitoring. On whole blood analyses, she was noted to have a methemoglobin level of 25.6%. She was treated with methylene blue. She recovered from cyanosis rapidly following treatment, and her vomiting stopped too.
3RD HOSPITAL DAY LABORATORY WORK UP:
Three days after admission the patient had a peripheral smear showing the following (Fig 5) "bite cells" (Degmacytes) which are cells with a smooth semicircle taken from one edge.
| 3rd Hospital Day LABORATORY WORK-UP Laboratory Data: Blood Tests |
||
|---|---|---|
| Test | Reference Range | Result |
| Urea Nitrogen | (6-18 mg/dl) | 20 mg/dl |
| Creatinine | (0.2-1.1 mg/dl) | 1.3 mg/dl |
| Total Bilirubin | (0.2-1.3 mg/dl) | 1.4 mg/dl |
| Gamma glutamyl transferase | (<44.0 Units/L) | 24 U/L |
| AST | (<40.0 Units/L) | 25 U/L |
| ALT | (<40.0 Units/L) | 25 U/L |
| Alk.Phosphatase | (<400 Units/L) | 97 U/L |
| Carbon Mono | <1% | 0.7% |
| Methehemoglobin | (0.0-3.0%) | 1.5% |
| pH Venous | (7.30-7.40) | 7.39 |
| PCO2 Venous | (41-51mm Hg) | 40 mm Hg |
| PO2 Venous | (35-45 mm Hg) | 47 mm Hg |
| HCO3 Venous | (22-26 mm Hg) | 24 mm Hg |
| Base Excess | (0-2 mm Hg) | 2 mm Hg |
| Hgb | (12.0-16.0 mg/dl) | 10.8 mg/dl |
| HCT | (36.0-46.0%) | 33.4% |
| RBC | (4.10-5.20) | 4.10 |
| MCV | (78.0-102.0) | 84.3 |
| MCH | (24.0-30.0) | 28.7 |
| MCHC | (32.0-36.0) | 34.3 |
| RDW | (11.8-15.2) | 12.3 |
| WBC | (4.5-13.0) | 7.2 |
| Neutrophils | (31-61%) | 81 |
| Lymphocytes | (28-48%) | 12* |
| Monocytes | (3-9%) | 8 |
| Eosinophils | (0-3%) | 1 |
| Basophils | (0-2%) | 0 |
| Platelets | (156-369%) | 40 |
  |
