UMEM Educational Pearls

Category: Toxicology

Title: Blue dye for the blue patient

Keywords: Methemoglobenima, methylene blue, adverse effects (PubMed Search)

Posted: 5/21/2014 by Kishan Kapadia, DO (Emailed: 5/22/2014)
Click here to contact Kishan Kapadia, DO

Methylene blue is an extremely effective antidote for acquired methemoglobinemia but has important adverse effects if given in excess of recommended dose.

Below is the usual dose of methylene blue for treatment of methemoglobinemia

1-2 mg/kg of 1% solution IV with a repeat dose given if there is inadequate response to the first one

Adverse effects include:

  • >4 m/kg -- Reversible skin, feces, and urine discoloration
  • 5-7 mg/kg -- EKG abnormalities (T-wave inversions, diminished R-waves), shortness of breath, chest discomfort, diaphoresis, nausea, diarrhea, abdominal discomfort
  • Paradoxically, between 4 and 15 mg/kg, it may cause methemoglobinemia


Lo, J et al. A review of methylene blue treatment for cardiovascular collapse. 2014 J Emerg Med 46(5):670-679.