Iloprost: The Hottest New Drug for the Coldest Emergency

While uncommon, methemoglobinemia is a medical emergency encountered in the emergency department, often related to medication exposure or toxins (nitrates, anesthetics, antimalarials, etc). Diagnosis is frequently delayed due to misleading pulse oximetry readings, unfamiliarity with co-oximetry interpretation, and overlap with other hypoxic conditions. Rapid recognition and appropriate pharmacologic management are key to preventing devastating outcomes. Emergency medicine (EM) pharmacists are knowledgeable about the medications implicated in methemoglobinemia and play a crucial role in identifying causative agents, guiding diagnostic interpretation and preventing medication errors associated with the administration of methylene blue. This presentation will discuss the pharmacologic management of methemoglobinemia, antidote stocking consensus recommendations, and how the EM pharmacist is in a pivotal position to optimize the therapies of choice.