Philippe Camus, M.D.

Dijon, France

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XXIII.a

Methemoglobinemia

Known since the 1940s (PMID 18883450). Comprehensive list of causal drugs and chemicals available at PMID 1564446. Methemoglobin is the oxidized (Fe3+) species of hemoglobin (Fe2+). Patients present with slate-grey cyanosis, low SpO2, normal SaO2 and PaO2. Normally, methemoglobin is <1%. Levels above 40% can be life-threatening, producing pulmonary edema, cardiovascular collapse (PMID 17122537) CNS disturbances and death. Management includes i.v. methylene blue. A possible rebound increase in MeHb upon treatment requires close monitoring. Excess methylene blue can also produce methemoglobinemia. Guidelines: PMID 34467556.

Publications

Hieger MA, Afeld JL, Cumpston KL, Wills BK

Topical Benzocaine and Methemoglobinemia.

American journal of therapeutics 2017 Sep/Oct;24;e596-e598 — 2017 Sep/Oct — e596-e598

Brown C, Bowling M

Methemoglobinemia in bronchoscopy: a case series and a review of the literature.

Journal of bronchology & interventional pulmonology 2013 Jul;20;241-6 — 2013 Jul — 241-6

Chowdhary S, Bukoye B, Bhansali AM, Carbo AR, Adra M, Barnett S, Aronson MD, Leffler DA

Risk of topical anesthetic-induced methemoglobinemia: a 10-year retrospective case-control study.

JAMA internal medicine 2013 May 13;173;771-6 — 2013 May 13 — 771-6

Vallurupalli S, Manchanda S

Risk of acquired methemoglobinemia with different topical anesthetics during endoscopic procedures.

Local and regional anesthesia 2011;4;25-8 — 2011 — 25-8

Doko Y, Iranami H, Fujii K, Yamazaki A, Shimogai M, Hatano Y

Severe methemoglobinemia after dental anesthesia: a warning about propitocaine-induced methemoglobinemia in neonates.

Journal of anesthesia 2010 Dec;24;935-7 — 2010 Dec — 935-7

Young B

Intraoperative detection of methemoglobinemia in a patient given benzocaine spray to relieve discomfort from a nasogastric tube: a case report.

AANA journal 2008 Apr;76;99-102 — 2008 Apr — 99-102

Shachor-Meyouhas Y, Galbraith R, Shavit I

Application of topical analgesia in triage: a potential for harm.

The Journal of emergency medicine 2008 Jul;35;39-41 — 2008 Jul — 39-41

Kwok S, Fischer JL, Rogers JD

Benzocaine and lidocaine induced methemoglobinemia after bronchoscopy: a case report.

Journal of medical case reports 2008 Jan 23;2;16 — 2008 Jan 23 — 16

Paparella S

Topical anesthetic sprays directly associated with a serious, sometimes fatal adverse drug reaction: methemoglobinemia.

Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association 2005 Oct;31;468-9 — 2005 Oct — 468-9

LeClaire AC, Mullett TW, Jahania MS, Flynn JD

Methemoglobinemia secondary to topical benzocaine use in a lung transplant patient.

The Annals of pharmacotherapy 2005 Feb;39;373-6 — 2005 Feb — 373-6

Balicer RD, Kitai E

Methemoglobinemia caused by topical teething preparation: a case report.

TheScientificWorldJournal 2004 Jul 15;4;517-20 — 2004 Jul 15 — 517-20

Byrne MF, Mitchell RM, Gerke H, Goller S, Stiffler HL, Golioto M, Branch MS, Jowell PS, Baillie J

The need for caution with topical anesthesia during endoscopic procedures, as liberal use may result in methemoglobinemia.

Journal of clinical gastroenterology 2004 Mar;38;225-9 — 2004 Mar — 225-9

Sinisterra S, Miravet E, Alfonso I, Soliz A, Papazian O

Methemoglobinemia in an infant receiving nitric oxide after the use of eutectic mixture of local anesthetic.

The Journal of pediatrics 2002 Aug;141;285-6 — 2002 Aug — 285-6