BACKGROUND: Methemoglobinemia is an uncommon cause of tissue hypoxia, but it can be life threatening if it is not identified and treated promptly. OBJECTIVES: To highlight the importance of understanding the potential risks of over-the-counter medications, especially in unsupervised use. Topical benzocaine must be used with caution, even in the healthy population. CASE REPORT: We report a case of methemoglobinemia secondary to topical benzocaine gel. A 6-year-old boy presented to our Pediatric Emergency Department with cyanosis, vomiting, and lethargy after using a gel-type, 7.5% benzocaine (Baby Orajel) for a toothache. Physical examination revealed dusky blue skin, tachycardia, tachypnea, and a normal neurologic examination. His percutaneous oxygen saturation remained 77-83% despite the administration of 100% oxygen. His arterial blood sample had a dark chocolate color appearance, and methemoglobinemia was suspected. His methemoglobin level was 69.9%, which is considered a lethal level. After a single dose of methylene blue (1 mg/kg/dose), cyanosis was reduced and oxygenation improved. CONCLUSION: Over-the-counter topical benzocaine should be used with caution, and the presence of methemoglobinemia must be promptly identified and treated. Copyright 2010 Elsevier Inc. All rights reserved.
BACKGROUND:Methemoglobinemia is an uncommon cause of tissue hypoxia, but it can be life threatening if it is not identified and treated promptly. OBJECTIVES: To highlight the importance of understanding the potential risks of over-the-counter medications, especially in unsupervised use. Topical benzocaine must be used with caution, even in the healthy population. CASE REPORT: We report a case of methemoglobinemia secondary to topical benzocaine gel. A 6-year-old boy presented to our Pediatric Emergency Department with cyanosis, vomiting, and lethargy after using a gel-type, 7.5% benzocaine (Baby Orajel) for a toothache. Physical examination revealed dusky blue skin, tachycardia, tachypnea, and a normal neurologic examination. His percutaneous oxygen saturation remained 77-83% despite the administration of 100% oxygen. His arterial blood sample had a dark chocolate color appearance, and methemoglobinemia was suspected. His methemoglobin level was 69.9%, which is considered a lethal level. After a single dose of methylene blue (1 mg/kg/dose), cyanosis was reduced and oxygenation improved. CONCLUSION: Over-the-counter topical benzocaine should be used with caution, and the presence of methemoglobinemia must be promptly identified and treated. Copyright 2010 Elsevier Inc. All rights reserved.
Authors: Lt Jessica L Wall; Lt Joshua B Wong; Lt Kyle J Kinderknecht; Cpt Leslie K Farrior; Daniel S Gabbay Journal: Can Fam Physician Date: 2016-02 Impact factor: 3.275
Authors: Elliot V Hersh; Sebastian G Ciancio; Arthur S Kuperstein; Eric T Stoopler; Paul A Moore; Sean G Boynes; Steven C Levine; Paul Casamassimo; Rina Leyva; Tanya Mathew; Othman Shibly; Paul Creighton; Gary E Jeffers; Patricia M A Corby; Stanley N Turetzky; Athena Papas; Jillian Wallen; Cynthia Idzik-Starr; Sharon M Gordon Journal: J Am Dent Assoc Date: 2013-05 Impact factor: 3.634