What Is Methemoglobinemia?

Methemoglobinemia is an uncommon medical condition that makes some of the red blood cells unable to transport oxygen. Symptoms can range from absent to mild to life-threatening.

Usually, methemoglobinemia results from certain toxins or overexposure to certain drugs, like some anesthetics (drugs used to reduce pain and sensation). A smaller number of people also have methemoglobinemia due to genetic problems present from birth. 

This article will discuss some of the causes and symptoms of methemoglobinemia, as well as its diagnosis, treatment, and related issues.

a cyanotic blue baby crying in pain and distress

Arindam Ghosh / iStock / Getty Images Plus

Methemoglobinemia Causes

Your red blood cells contain an important protein called hemoglobin. In its normal state, this protein transports life-giving oxygen to all the cells of your body. Specifically, iron in the hemoglobin picks up oxygen that is taken around the body. Hemoglobin also gives blood its reddish color. 

Methemoglobin is a form of hemoglobin that is a little different from normal hemoglobin. Because of a slight difference in the form of iron it contains, it can’t pick up oxygen normally, so it can’t take it to parts of the body that need it. 

Methemoglobin is usually present at low levels in the body (less than 1% of total hemoglobin). However, when this percentage increases, it can cause problems. In methemoglobinemia, at least 3% or more of a person’s hemoglobin is in the form of abnormal methemoglobin.

Who Is at Risk?

Methemoglobinemia can result from genetic problems (this is called inherited methemoglobinemia), or something in the environment might change the configuration of some of a person’s hemoglobin to methemoglobin (acquired methemoglobinemia).

People with certain health conditions, like lung disease, heart disease, or anemia (lack of healthy red blood cells) also have an increased risk of developing methemoglobinemia.

Methemoglobinemia Symptoms

If you have only a little more methemoglobin in your blood than normal, you might not notice any symptoms. 

Because the body does a good job of compensating, people with mild, chronic methemoglobinemia might only learn of it when undergoing medical tests for other reasons. Sometimes methemoglobinemia only becomes apparent when a person is experiencing other problems, like recovering from surgery in the intensive care unit (ICU).

In contrast, if you have a higher percentage of methemoglobin, you could have life-threatening issues. 

Some possible symptoms are:

  • Blue color to the skin and lips (cyanosis)
  • Weakness
  • Dizziness
  • Nausea
  • Shortness of breath
  • Brownish blood

With severe methemoglobinemia, symptoms might include:

Death is also possible in severe situations. 

Inherited Forms of Methemoglobinemia

Inherited methemoglobinemia (also called autosomal recessive methemoglobinemia or congenital methemoglobinemia) is caused by rare genetic problems present from birth. Different genetic problems lead to different levels of severity, which sometimes need slightly different treatments. There are two forms of inherited methemoglobinemia: types 1 and 2.

People with type 1 congenital methemoglobinemia often have an average lifespan and don't experience complications.

The affected gene in type 2 inherited methemoglobinemia leads to a problem with a protein (called cytochrome 5 reductase). This protein helps keep the iron in the right configuration for regular hemoglobin (and not methemoglobin). 

People with type 2 congenital methemoglobinemia have a severe problem with this protein. Because of this, symptoms are most severe for people with type 2 congenital methemoglobinemia. Most people with type 2 die in infancy. They also tend to have developmental delays and other neurological issues.

Other congenital disorders can also cause increased levels of methemoglobin. These include:

Acquired Methemoglobinemia

Exposure to certain drugs or toxins can also trigger methemoglobinemia in some people. Some examples are:

  • Anesthetics such as Xylocaine (lidocaine)
  • Antibiotics like Aczone (dapsone
  • Antimalarials like chloroquine
  • Nitrites, such as from contaminated well water
  • Pesticides, including exposure in farmers

However, not everyone exposed to these substances develops methemoglobinemia. Some people have a greater tendency toward developing it than others.

Warning on Teething Products

Because of the risks of methemoglobinemia, the Food and Drug Administration (FDA) recommends against using over-the-counter teething products that include benzocaine (e.g., Orajel) in children younger than 2. Silicone teething rings are a good alternative.

Learn More: A Guide to Infant Teething


A person’s symptoms, medical history, and physical exam results all provide important clues to consider methemoglobinemia. Certain medical tests also give key information. Some of these might be:

  • Arterial blood gas: A test that measures the acidity (pH) and carbon dioxide and oxygen levels in the blood from an artery
  • Co-oximetry: Analyzes blood gases, including hemoglobin and dyshemoglobins (hemoglobin that can't transport oxygen such as methemoglobin)
  • Pulse oximetry: An electric device that measures oxygen saturation in your red blood cells

These all give information about the oxygenation status within your blood. The latter is less accurate, but unlike the others, you don't have to directly access a person's blood. Pulse oximetry screening can also sometimes help identify infants born with methemoglobinemia.

Other tests may also be necessary to rule out other more common causes of a person’s symptoms related to low oxygen (hypoxia).

Unlike most other people showing symptoms from poor levels of oxygen, people with methemoglobinemia don’t improve when given pure oxygen to breathe. This can be a clue that methemoglobinemia might be the problem.

Because methemoglobinemia is relatively rare but often reversible, it’s especially important that healthcare providers consider it as a possibility. 

Additional testing, such as genetic tests, may be needed for inherited forms of the disease.


Treatment can vary based on the severity of methemoglobinemia, whether it is a sudden or chronic issue, and whether it is from exposure or a genetic cause. Severe methemoglobinemia requires immediate emergency treatment, but someone who has chronic mild methemoglobinemia may not need any treatment at all.

Some potential treatments include:

  • Removal of the triggering substance 
  • Infusion of methylene blue (promotes the conversion of methemoglobin to normal hemoglobin)
  • Vitamin C (ascorbic acid)
  • Vitamin B2 (riboflavin)
  • Hyperbaric oxygen therapy (breathing pure oxygen in a pressurized environment)
  • Red blood cell transfusion (in severe cases)


If promptly diagnosed and treated, people with acquired methemoglobinemia typically completely recover without complications. 


People who have inherited forms of methemoglobinemia should avoid drugs known to trigger methemoglobinemia in some people. Information regarding this should be available on the drug's labeling information. Even if you’ve never had symptoms from it yourself, this information may be important if someone in your family has ever had such a problem. 

When starting new medications or considering surgery, discuss this complete medical history with your healthcare provider. You might need a different medication, or your surgical team may need to take additional precautions.


Methemoglobinemia is a medical condition in which much of your hemoglobin can’t transport oxygen normally because it is in the form of methemoglobin. It can be present from birth or triggered by something later in life. Symptoms might be absent, mild, or life-threatening, depending on severity. While severe methemoglobinemia requires immediate emergency treatment, those with mild methemoglobinemia may not need any treatment.

A Word From Verywell

It can be frightening to learn that you or a loved one has methemoglobinemia. The good news is that we have excellent treatments for acquired methemoglobinemia, even though its initial symptoms might be serious. Also, most people with inherited disease have a subtype with manageable symptoms and an average life span.

Frequently Asked Questions

  • How do you pronounce methemoglobinemia?

    Methemoglobinemia is met·HEE·muh·glow·buh·NEE·mee·uh. The protein itself is methemoglobin, pronounced met·HEE·muh·glow·bin.

  • How long does it take for acquired methemoglobinemia to resolve?

    This depends on the severity of your exposure, the promptness of treatment and diagnosis, and your other medical conditions. However, symptoms usually go away within a few hours or less of receiving treatment with methylene blue.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Trivedi DJ, Joshiraj B, Bidkar V, Rao R. Methemoglobinemia: Living with dormant devil. Indian J Clin Biochem. 2017;32(2):248-250. doi:10.1007/s12291-016-0586-5

  2. Viršilas E, Timukienė L, Liubšys A. Congenital methemoglobinemia: Rare presentation of cyanosis in newborns. Clin Pract. 2019;9(4):1188. doi:10.4081/cp.2019.1188

  3. Cefalu JN, Joshi TV, Spalitta MJ, et al. Methemoglobinemia in the operating room and intensive care unit: Early recognition, pathophysiology, and management. Adv Ther. 2020;37(5):1714-1723. doi:10.1007/s12325-020-01282-5

  4. Ponce Ríos JD, Yong R, Calner P. Code blue: Life-threatening methemoglobinemiaClin Pract Cases Emerg Med. 2019;3(2):95-99. doi:10.5811/cpcem.2019.3.41794

  5. US Food and Drug Administration. Risk of serious and potentially fatal blood disorder prompts FDA action on oral over-the counter benzocaine products used for teething and mouth pain and prescription local anesthetics.

  6. Ward J, Motwani J, Baker N, Nash M, Ewer AK, Toldi G. Congenital methemoglobinemia identified by pulse oximetry screening. Pediatrics. 2019 Mar;143(3):e20182814. doi:10.1542/peds.2018-2814

By Ruth Jessen Hickman, MD
Ruth Jessen Hickman, MD, is a freelance medical and health writer and published book author.