The Drug-Induced Respiratory Disease Website
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
Seizures and Methemoglobinemia After Topical Application of Eutectic Mixture of Lidocaine and Prilocaine on a 3.5-Year-Old Child with Molluscum Contagiosum and Atopic Dermatitis.
Pediatric dermatology 2016 Sep;33;e284-5 — 2016 Sep — e284-5
Lidocaine-induced methemoglobinemia: a clinical reminder.
The Journal of the American Osteopathic Association 2015 Feb;115;94-8 — 2015 Feb — 94-8
[Methaemoglobinaemia in a child treated with Emla(®) cream: circumstances and consequences of overdose].
Annales de dermatologie et de venereologie 2012 Dec;139;824-7 — 2012 Dec — 824-7
Risk of acquired methemoglobinemia with different topical anesthetics during endoscopic procedures.
Local and regional anesthesia 2011;4;25-8 — 2011 — 25-8
Application of topical analgesia in triage: a potential for harm.
The Journal of emergency medicine 2008 Jul;35;39-41 — 2008 Jul — 39-41
Benzocaine and lidocaine induced methemoglobinemia after bronchoscopy: a case report.
Journal of medical case reports 2008 Jan 23;2;16 — 2008 Jan 23 — 16
Severe methemoglobinemia from topical anesthetic spray: case report, discussion and qualitative systematic review.
CJEM 2001 Jan;3;51-6 — 2001 Jan — 51-6
Severe methemoglobinemia following dental extractions under lidocaine anesthesia.
Anesthesiology 1956 Jan;17;204 — 1956 Jan — 204