This case report documents a 35-year-old patient who developed acquired methemoglobinemia (19% methemoglobin level) after ingesting an Ayurvedic herbal decoction, presenting with refractory hypoxemia, cyanosis, and seizure activity. The patient rapidly recovered following intravenous methylene blue treatment, demonstrating the compound’s therapeutic efficacy in reversing methemoglobinemia. The case highlights a critical safety concern: herbal and traditional remedies are underreported but significant causes of methemoglobinemia, and practitioners must recognize the characteristic saturation gap and chocolate-brown blood discoloration as diagnostic red flags.
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IV methylene blue rapidly reversed herbal-induced methemoglobinemia; consider it when saturation gap and chocolate-brown blood appear.