We report a case of rebounding severe methaemoglobinaemia secondary to sodium nitrite ingestion, despite several administrations of methylene blue. The patient's clinical course was characterised by a series of alternating improvements and deteriorations and proved challenging for treating clinicians. On discussion with poisoning experts, it was hypothesised that a small amount of sodium nitrite remained in the gastrointestinal tract leading to prolonged absorption of the causative agent. Methaemoglobin levels returned to normal following the administration of multi-dose activated charcoal via a nasogastric tube 30 h after the initial presentation to hospital.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366772PMC
http://dx.doi.org/10.1002/anr3.12320DOI Listing

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