Methemoglobinemia Precipitated by Benzocaine Used During Intubation
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Abstract:
Methemoglobinemia is a rare cause of tissue hypoxia that can quickly become fatal without immediate recognition and prompt treatment. It refers to an increase in methemoglobin in the red blood cells, which can be due to genetic deficiency of the enzymes responsible for reducing hemoglobin or can develop after exposure to oxidizing agents or xenobiotics. Local anesthetics, particularly benzocaine, have long been implicated in the formation of methemoglobin. Benzocaine is used for teething pain as well as before invasive procedures such as intubation and transesophageal echocardiogram. In this case report, we describe a patient with acute appendicitis who developed severe methemoglobinemia following use of benzocaine during an emergent intubation. Our objective is to increase awareness of this rare but potentially fatal complication associated with the use of this anesthetic.Keywords:
Benzocaine
Methemoglobinemia
Methemoglobin
Methemoglobinemia developed in three dogs after the owners' use of benzocaine-containing products for topical treatment of the dogs' pruritic skin conditions. The products were intended for use in man. In two of the dogs, clinical signs of shock were observed within a few hours after the application of a skin lotion containing 5% benzocaine. Methemoglobin was assayed in one case and found to be 51% of total hemoglobin. Both dogs recovered after whole blood transfusions were given. The third dog, which had been treated for several weeks with small amounts of an anesthetic aerosol containing 20% benzocaine, was anorectic and lethargic when examined. Methemoglobin content was 30%, and Heinz bodies were observed in 20% of the erythrocytes. The methemoglobin content and proportion of Heinz bodies decreased rapidly after use of the spray was discontinued. The two benzocaine-containing products incriminated in development of the methemoglobinemia did not induce measurable increases in methemoglobin content in clinically normal dogs, when applied to unbroken skin. Small increases in methemoglobin content were measured, however, when these products were given orally to clinically normal dogs. It was concluded that the skin lesions in the three clinically affected dogs enhanced absorption of the drug, resulting in methemoglobin formation.
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Benzocaine‐induced methemoglobinemia is a rare but life‐threatening event. The use of topical benzocaine spray in a 77‐year‐old woman during endoscopic retrograde cholangiopancreatogram produced marked cyanosis and mrthemoglobin levels consistent with methemoglobinemia. Immediate recognition and prompt treatment of the disorder are essential to decrease morbidity and mortality.
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Background; Methemoglobinemia is a rare disorder of the blood in which there is an increase in the proportion of hemoglobin present in the oxidized form (methemoglobin). It may be inherited, due either to a deficiency of methemoglobin reductase or to a structural abnormality of hemoglobin, or it may be acquired, usually secondary to exposure to drugs or chemicals that oxidize hemoglobin l. Administration of some local anesthetics such as benzocaine at large doses may lead to an acute effect of risk Methemoglobinemia.. Presentation ; A 6-years-old child was suffering from dyspnea, headache, and grayish in appearance. The patient was self-treating with an over-the-counter topical oral benzocaine. Treatment; The diagnosis of methemoglobinemia was made in conjunction with consultation with a medical toxicologist and treatment with oxygen and methylene blue as antidote was given 1mg/kg of 1% solution intravenously over 7minutes. The symptoms improved within 30 minutes and child felt markedly better within 1.5 hour. Conclusion; Methylene blue is the specific antidote, but should be reserved for more severe cases.
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Methylene blue
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Methemoglobin is formed upon iron oxidation of the heme molecule from ferrous (Fe2+) to its ferric (Fe3+) state. Normal methemoglobin levels in the body vary between 1-2% of the total hemoglobin. Cause of methemoglobinemia can be inherited or acquired. Inherited causes include an enzymatic deficiency in the enzyme cytochrome b5 reductase where as acquired causes are most commonly from routinely used medications. Herein, we present to you a case of methemoglobinemia after Cetacaine (a benzocaine based topical anesthetic) utilization during a transesophageal echocardiography. Some of the other common potential inciting agents are also discussed here along with an overview of treatment strategies.
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Methemoglobinemia
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Venous blood
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Methemoglobinemia (MetHb) is a clinical and laboratory syndrome characterized by an increase in the amount of methemoglobin in the blood and is usually manifested by central cyanosis caused by a decrease in oxygen delivery to tissues. MetHb is a diagnosis of exclusion because the diagnostic possibilities can be difficult due to the high variability in clinical manifestations (from asymptomatic to fatal) and the need for laboratory confirmation. Authors present the classification, pathophysiological mechanisms of MetHb and methods of treatment. A clinical case observation of a severe acquired MetHb in a child in connection with the intake of benzocaine contained in the ointment is presented as well: the timely diagnosis and treatment have led to stop the manifestations of MetHb.
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Methemoglobinemia
Methemoglobin
Benzocaine
Transesophageal echocardiogram
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Benzocaine
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Methemoglobinemia
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Background; Methemoglobinemia is a rare disorder of the blood in which there is an increase in the proportion of hemoglobin present in the oxidized form (methemoglobin). It may be inherited, due either to a deficiency of methemoglobin reductase or to a structural abnormality of hemoglobin, or it may be acquired, usually secondary to exposure to drugs or chemicals that oxidize hemoglobin l. Administration of some local anesthetics such as benzocaine at large doses may lead to an acute effect of risk Methemoglobinemia.. Presentation ; A 6-years-old child was suffering from dyspnea, headache, and grayish in appearance. The patient was self-treating with an over-the-counter topical oral benzocaine. Treatment; The diagnosis of methemoglobinemia was made in conjunction with consultation with a medical toxicologist and treatment with oxygen and methylene blue as antidote was given 1mg/kg of 1% solution intravenously over 7minutes. The symptoms improved within 30 minutes and child felt markedly better within 1.5 hour. Conclusion; Methylene blue is the specific antidote, but should be reserved for more severe cases.
Methemoglobinemia
Benzocaine
Methemoglobin
Antidote
Methylene blue
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