Methemoglobinemia with a saturation gap
Educational use only. Not clinically reviewed42-year-old woman for calm discordance recognition, escalation, bounded antidote intent, reassessment, and handoff practice. About 6 simulated minutes.
What you will practise
- Reconcile the exposure, cyanosis, symptoms, pulse oximetry, arterial oxygen evidence, and whole patient.
- Recognize a dyshemoglobin pattern without relying on one number or closing the diagnosis.
- Activate support, monitoring, source control, and qualified toxicology and critical-care ownership.
- Review supplied co-oximetry and the methylene-blue hazard boundary.
- Record bounded qualified-team antidote intent, then reassess a strict later report.
- Hand off exposure, rebound, hemolysis, serotonin, rescue, and active risk.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- American Heart Association. 2023 Focused Update on Life-Threatening Toxicity Due to Poisoning. Circulation. 2023;148:e149-e184. doi:10.1161/CIR.0000000000001161.
- Iolascon A, et al. Recommendations for diagnosis and treatment of methemoglobinemia. Am J Hematol. 2021;96(12):1666-1678. PMID:34467556.
- DailyMed. Methylene Blue Injection prescribing information. Set ID 4f222ee5-df03-46d5-a060-c63565b7186f. Updated 2026-02-09.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.