Methemoglobinemia: An Industrial Outbreak Among Rubber Molding Workers

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Objective:This case series documents an occupational outbreak of methemoglobinemia among five steam press operators at a rubber plant. Investigative findings identified the cause as repeated exposure (through manual handling) to an adhesive containing dinitrobenzene.Results:The workers presented with yellow-stained hands and a variety of clinical manifestations. Methemoglobinemia levels obtained in the emergency room ranged from 3.8% to 41.2%. Methylthioninium chloride (methylene blue) rapidly reversed the cyanosis and alleviated associated symptoms in the rubber molding workers requiring treatment.Conclusions:Prompt action by plant officials and subsequent investigation by National Institute of Occupational Safety and Health/Occupational Safety & Health Administration personnel resulted in the timely and successful resolution of the problem. Individual presentations, assessment, and management are discussed along with recommendations for occupational investigation and referral.

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