A 32 yo male suffering from dental pain for the past several days presents to the ED complaining of abdominal pain. He notes ingesting large quantities of acetaminophen for the pain. Your triage nurse notes he is hypoxic on RA at 86%, but oddly this does not rise when the patient is placed on oxygen....

An intubated 32 year old female is brought to the ED in cardiac arrest. Family was suspecting that this was an overdose.\ given a recent hospitalization for acetaminophen overdose. EMS reports that on arrival the patient had a bluish discoloration to the skin, and she is now extrememly pale with the appearance of a cadaver. What could have caused this clinical picture? Read on for a discussion of a very rare but extremely deadly poisoning...

Interesting case of a cyanotic patient lately? Looking for good questions to pimp medical students or residents with (had an attending in residency who always loved to ask about way he only recommended pyridium for use for a couple of days for UTI symptoms)? Studying for boards? Below are some teaching points on methemoglobinemia.