Patients with central cyanosis should be started on supplemental oxygen. Failure to improve suggests either impaired circulation (shock), abnormal hemoglobin, or pseudocyanosis.
In acquired methemoglobinemia, no treatment is necessary unless signs of hypoxia (i.e., angina, arrhythmias, hypotension, stupor, or coma) are present. Methylene blue in a dose of 1 to 2 mg/kg of body weight given intravenously over 5 min as a 1% solution (0.1 to 0.2 ml/kg) is the antidote for acquired methemoglobinemia. Caution should be taken whenever methylene blue is used; by itself, at high doses, it can cause hemolysis or even precipitate methemoglobinemia and possibly worsen the patient's condition.
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