{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T12:23:02Z","timestamp":1756902182980,"version":"3.44.0"},"reference-count":8,"publisher":"The Pediatric Pharmacy Association","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019]]},"abstract":"<jats:p>A case of methemoglobinemia (MHb) in a teenage woman, triggered by an acute ingestion of approximately 120 to 180 mg of cetirizine, allegedly, with no suicidal intent is described. The patient presented with anxiety and tremors and rapidly developed central cyanosis unresponsive to oxygen supplementation. There was a history of recurrent, spontaneously remitting, unprovoked \u201cblue discoloration of hands.\u201d Investigations confirmed the diagnosis of MHb, and the patient responded to ascorbic acid and methylene blue, although the baseline methemoglobin level remained slightly high. The exact enzymatic deficiency could not be ascertained as the patient refused to undergo complete testing. To the best of our knowledge, this is the first documentation of cetirizine as a causative agent for drug induced MHb. Cetirizine, a selective histamine H1 receptor antagonist is eliminated via oxidation and conjugation processes, which use pathways other than cytochrome P450 enzyme system. The metabolism could potentially create by-products, like superoxide or hydrogen peroxide, which could act as strong reducing agents and oxidize hemoglobin into ferric containing methemoglobin. In this case, an unusually high systemic load of the drug speculatively saturated and overwhelmed the protective enzyme systems, which resulted in clinical manifestation of MHb.<\/jats:p>","DOI":"10.5863\/1551-6776-24.6.538","type":"journal-article","created":{"date-parts":[[2019,11,6]],"date-time":"2019-11-06T17:12:37Z","timestamp":1573060357000},"page":"538-541","source":"Crossref","is-referenced-by-count":0,"title":["Cetirizine as a Causative Agent for Drug Induced Methemoglobinemia: A Case Report and Review"],"prefix":"10.5863","volume":"24","author":[{"given":"Matthew","family":"Grillo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Hong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sujatha","family":"Kosuri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Verma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3883","reference":[{"issue":"7","key":"i1551-6776-24-6-538-b1","series-title":"Del Med J","first-page":"203","article-title":"Methemoglobinemia: a systematic review of the pathophysiology, detection, and treatment","volume":"83","year":"2011","unstructured":"Ashurst\n              J\n            , WassonM.\n          Methemoglobinemia: a systematic review of the pathophysiology, detection, and treatment. Del Med J. 2011;83(7):203\u2013208."},{"issue":"3","key":"i1551-6776-24-6-538-b2","series-title":"West J Med","first-page":"193","article-title":"Methemoglobinemia: evidence based case review","volume":"175","year":"2001","unstructured":"Rehman\n              HU.\n            \n          \n          Methemoglobinemia: evidence based case review. West J Med. 2001;175(3):193\u2013196."},{"issue":"1","key":"i1551-6776-24-6-538-b3","series-title":"Am J Physiol","first-page":"56","article-title":"The effect of methemoglobin on the equilibrium between oxygen and hemoglobin","volume":"137","year":"1942","unstructured":"Darling\n              AU\n            , RoughtonR.\n          The effect of methemoglobin on the equilibrium between oxygen and hemoglobin. Am J Physiol. 1942;137(1):56\u201368."},{"issue":"1","key":"i1551-6776-24-6-538-b4","series-title":"Expert Opin Pharacother","first-page":"125","article-title":"Review of cetirizine hydrochloride for the treatment of allergic disorder","volume":"5","year":"2005","unstructured":"Portnoy\n              JM\n            , DinakarC.\n          Review of cetirizine hydrochloride for the treatment of allergic disorder. Expert Opin Pharacother. 2005;5(1):125\u2013135."},{"issue":"5","key":"i1551-6776-24-6-538-b5","series-title":"Medicine (Baltimore)","first-page":"265","article-title":"Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals","volume":"83","year":"2004","unstructured":"Ash-Bernal\n              R\n            , WiseR, WrightSM.\n          Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals. Medicine (Baltimore). 2004;83(5):265\u2013273."},{"key":"i1551-6776-24-6-538-b6","series-title":"Case Rep Emer Med","article-title":"A case report of prilocaine-induced methemoglobinemia after liposuction procedure","volume":"2015","year":"2015","unstructured":"Yildirim\n              B\n            , KaragozU, AcarE, \n          et al. A case report of prilocaine-induced methemoglobinemia after liposuction procedure. Case Rep Emer Med. 2015;2015:282347. doi:10.1155\/2015\/282347."},{"issue":"5","key":"i1551-6776-24-6-538-b7","series-title":"Ann Emerg Med","first-page":"646","article-title":"Methemoglobinemia: etiology, pharmacology, and clinical management","volume":"34","year":"1999","unstructured":"Wright\n              R\n            , LewanderW, WoolfA.\n          Methemoglobinemia: etiology, pharmacology, and clinical management. Ann Emerg Med. 1999;34(5):646\u2013656."},{"issue":"5","key":"i1551-6776-24-6-538-b8","series-title":"Am J Hematol","first-page":"474","article-title":"A patient with both methemoglobinemia and G6PD deficiency: a therapeutic conundrum","volume":"92","year":"2017","unstructured":"Reading\n              NS\n            , Ruiz-BonillaJA, ChristensenRD, \n          et al. A patient with both methemoglobinemia and G6PD deficiency: a therapeutic conundrum. Am J Hematol. 2017;92(5):474\u2013477."}],"container-title":["The Journal of Pediatric Pharmacology and Therapeutics"],"original-title":[],"link":[{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/24\/6\/article-p538.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/jppt\/article-pdf\/24\/6\/538\/2466663\/1551-6776-24_6_538.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/24\/6\/article-p538.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/24\/6\/article-p538.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:42:23Z","timestamp":1747356143000},"score":1,"resource":{"primary":{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/24\/6\/article-p538.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019]]},"references-count":8,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.5863\/1551-6776-24.6.538","relation":{},"ISSN":["1551-6776"],"issn-type":[{"type":"print","value":"1551-6776"}],"subject":[],"published":{"date-parts":[[2019]]}}}