• Elspeth Hulse, Fathima Shihana, and Nicholas A Buckley.
• a Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh , UK.
• Clin Toxicol (Phila). 2016 Nov 1; 54 (9): 826-828.

IntroductionIn Asia methemoglobinemia (MetHb) is commonly caused through self-poisoning with the pesticide propranil. MetHb can cause hypoxia, coma and death, but usually responds to methylene blue. It is therefore vital to have accurate methods to measure blood MetHb to guide appropriate treatments. The gold standard to measure MetHb utilizes a spectrophotometer, but recent bedside tests have been developed e.g., pulse co-oximeter probe and blood color chart.MethodsNine propanil poisoned patients had data collected from hospitals in Sri Lanka during 2008. Several MetHb readings were taken from each patient from admission up to 50 hours using spectrophotometry (Unico UV-Vis model no. 2800), pulse co-oximetry (Radical-7, Masimo, CA), and color chart.ResultsThe co-oximeter underestimated the MetHb percentage when compared with spectrophotometry and the color chart, especially when the average MetHb was greater than 20%. The color chart demonstrated acceptable accuracy compared with formal spectrophotometry with the majority of values showing no more than 10% difference.ConclusionThis small cohort highlights the potential for extreme inaccuracy of the Radical-7 co-oximeter, especially with a MetHb greater than 20%. Pulse co-oximeters should be required to be validated for the complete range of MetHb prior to regulatory approval.

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