2,4,6-Trinitrotoluene

CAS RN:118-96-7

Laboratory

A) In a cyanotic patient, a methemoglobin level should be obtained to confirm the diagnosis. Methemoglobin levels will be artificially low if blood is not analyzed within a few hours.
B) Pulse oximetry may give a false reading in the 80% to low 90% range. An arterial blood gas test will reveal a falsely normal calculated oxygen saturation despite low measured pulse oximetry. If oxygen saturation is measured, it will be low relative to the pO2. This saturation gap suggests methemoglobinemia.
C) An ECG should be obtained to screen for myocardial ischemia. Cardiac biomarkers should be obtained if evidence of ischemia is present on ECG.
D) A CBC with microscopy should be performed to evaluate for hemolysis.
E) Blood with more than 15% methemoglobinemia will appear chocolate brown and may be an early bedside indication of methemoglobinemia.
F) If chronic cyanosis (not due to pulmonary disease) is present, especially if a family history of cyanosis is suggested, hemoglobin electrophoresis, methemoglobin reductase level, and/or G-6-PD activity may be indicated.
A) A number of chemicals produce abnormalities of the hematopoietic system, liver, and kidneys. Monitoring complete blood count, urinalysis, and liver and kidney function tests is suggested for patients with significant exposure.
B) If respiratory tract irritation or respiratory depression is evident, monitor arterial blood gases, chest x-ray, and pulmonary function tests.
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