Case of methaemoglobinaemia caused by tree oils and kerosene

BMJ Case Rep. 2017 Sep 23:2017:bcr2017220802. doi: 10.1136/bcr-2017-220802.


We report a case of a young man who allegedly consumed 100 mL of an indigenous pesticide which is used for the killing of rats in households in India. The constituents were azadirachtin oil (40%), tea oil (15%), pine oil (25%) and kerosene oil (20%). He presented to us with shortness of breath and altered sensorium and was found to have fMetHb (fraction of methaemoglobin) level of 80%, which has been postulated to have a fatal outcome. He responded to a low dose of methylene blue along with intravenous vitamin C and the level of fMetHb came down to 20% within 1 hour. His sensorium improved markedly with a decrease in fMetHb to non-toxic levels and he was discharged 5 days after admission. A literature review pertaining to these constituents individually or in combination causing methaemoglobinaemia is discussed in the context of this case.

Keywords: poisoning; resuscitation.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Ascorbic Acid / administration & dosage
  • Ascorbic Acid / therapeutic use
  • Diagnosis, Differential
  • Emergency Treatment
  • Humans
  • Infusions, Intravenous
  • Kerosene / poisoning*
  • Male
  • Methemoglobinemia / chemically induced
  • Methemoglobinemia / diagnosis*
  • Methemoglobinemia / drug therapy
  • Methylene Blue / administration & dosage
  • Methylene Blue / therapeutic use
  • Pesticides / poisoning*
  • Plant Oils / poisoning*
  • Suicide, Attempted*


  • Kerosene
  • Pesticides
  • Plant Oils
  • Ascorbic Acid
  • Methylene Blue