A burn patient being treated with nitrates developed methemoglobinemia, which further complicated the respiratory care required for smoke inhalation and underlying lung disease. Methemoglobinemia has been associated with silver nitrate therapy in burn patients, when the patients displayed infection with certain organisms capable of reducing nitrates to nitrites. The absorbed nitrites convert hemoglobin to methemoglobin, which does not bind oxygen and serves no respiratory function. The recognition of methemoglobinemia in burn patients is sometimes difficult but is essential to adequate respiratory care, particularly in patients with primary insult to the lungs.
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