COVID-19 and Stress: A Young Male Presenting with Central Cyanosis, Dark Urine, Oliguria, Jaundice and Anemia due to Methemoglobinemia as a result of Suicidal Naphthalene Mothball Poisoning Recovered with Exchange Transfusion
K. Pyar, S. Hlaing, A. Aung, Z. Aung, N. L. Maung, K. Myat, K. Lwin, L. Maung, Ye Min Hein, Lynn Htet Aung, Chan Pyae Aung, Moe Tun Zaw, M. Maung, A. Kyaw, Thurein Win, Kyaw Zay Ya, Myo Thant Kyaw, Z. Oo, Zay Phyo Aung, A. Thu
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Abstract
A young man presented with abdominal pain and vomiting after eating Naphthalene Mothball. He had dyspnea, central cyanosis (SaO2 on air was 67% on air), marked pallor, deep jaundice and dehydration. His urine color was black; and, his plasma in clotted blood sample was brownish. He was treated as methemoglobinemia due to suicidal Naphthalene Mothball poisoning with fluid and electrolyte replacement, ascorbic acid, N-acetylcystine and exchange transfusion twice with four units of whole blood. Dramatic improvement in central cyanosis immediately following exchange transfusion. Psychiatric consultation and counselling were done; he admitted the main reason for committing suicide was socioeconomic stress due to COVID-19.
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