Most cases of methemoglobinemia are acquired and result from exposure to certain drugs or toxins. One of the more common causes of acquired methemoglobinemia is exposure to topical benzocaine during medical procedures.
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Having said that, what are the three possible causes of methemoglobinemia?
People have developed methemoglobinemia after having medical procedures that used certain topical anesthetics that are often sprayed on to the skin. These include benzocaine, lidocaine, and prilocaine.
In any case, which of the following is most likely to cause methemoglobinemia? Certain drugs are more likely to cause methemoglobinemia than others. These are dapsone, local anesthetics, phenacetin, and antimalarial drugs.
Thus, which drug can cause methemoglobinemia?
Drugs that may cause Methemoglobinemia include nitrates derivatives (nitrates salt, nitroglycerin), nitrites derivatives (nitroprusside, amyl nitrite, nitric oxide), sulfonamides, dapsone, phenacetin, phenazopyridine, some local anesthetics such as prilocaine, topical anesthetics such as emla cream, benzocaine, ...
What are the chances of getting methemoglobinemia?
Conclusions and relevance: The overall prevalence of methemoglobinemia is low at 0.035%; however, an increased risk was seen in hospitalized patients and with benzocaine-based anesthetics.
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Vitamin C is recommended for treatment of methemoglobinemia. It has been demonstrated that the reduction of the methemoglobin formation occurs at low vitamin C concentration in mice erythrocytes.
Methylene blue is used to treat severe cases of MetHb, and doctors may prescribe ascorbic acid to reduce the level of methemoglobin in the blood. In severe cases, a person may require a blood transfusion or exchange transfusion. Oxygen therapy will also be provided, if required.
Benzocaine, a local anesthetic, can cause a condition in which the amount of oxygen carried through the blood is greatly reduced. This condition, called methemoglobinemia, can be life-threatening and result in death.
“A rare but very noticeable condition of abnormal hemoglobin affects the “blue people of Troublesome Creek”. Seven generations ago, in 1820, a French orphan named Martin Fugate who settled in this area of Kentucky brought in an autosomal recessive gene that causes methemoglobinemia.
The onset of methemoglobinemia is usually within 20 to 60 minutes of drug administration. Normally, 5 g/dL of deoxyhemoglobin (compared with 1.5 g/dL [10%–15%] of methemoglobin) produces noticeable cyanosis.
Methemoglobinemia is a potentially severe complication of lidocaine and benzocaine, especially when used concomitantly. Among the acquired causes of methemoglobinemia, although caine-induced methemoglobinemia is rare, it may have a fatal outcome.
In fact, the agency concluded Baby Orajel and other over-the-counter benzocaine products marketed for teething pain can on occasions lead to serious —and sometimes fatal — methemoglobinemia. For this reason, the FDA recommends that parents and caregivers not use benzocaine products in children younger than two.
— Nitrites and nitrates are well-recognized causes of acquired methemoglobinemia. Nitroglycerin has been reported to cause methemoglobinemia in animals. We report on a patient in whom we believe methemoglobinemia developed from an accidental overdose of nitroglycerin.
Drinking water with high nitrate can cause a potentially fatal disorder called methemoglobinemia.
Although the two local anesthetics usually do not cause methemoglobinemia, we suspect that the displacement of lidocaine from protein binding by bupivacaine, in combination with metabolic acidosis and treatment with other oxidants, was the reason for the development of methemoglobinemia.
Severe Precaution: Increased risk for developing methemoglobinemia. Consult clinician prior to use. Severe Precaution: Increased risk for developing methemoglobinemia.
Recognition and avoidance of precipitating factors are important for prevention of methemoglobinemia, especially in susceptible populations. Monitoring of well water levels may be needed.
Of the 319 cases, 7 were deaths, 32 cases were categorized as life threatening, and 216 were categorized as serious. A review of the 319 cases indicated that the development of methemoglobin emia after treatment with benzocaine sprays may not be related to the amount applied.
The diagnosis is confirmed by direct measurement of methemoglobin by a multiple wavelength co-oximeter. On a blood gas, normal PaO2 concentrations are usually found on analysis. Clinical cyanosis in the presence of normal arterial oxygen tensions is highly suggestive of methemoglobinemia.
Severe hemolysis due to G6PD deficiency may manifest as methemoglobinemia,4 in which the heme iron is in the oxidized ferric state rather than the ferrous state.
After 10 min, oxygen saturation
began to increase and an hour later reached its normal levels. Methemoglobin levels were found to be 24.5% before ascorbic acid administration. After 24 hour of administration, methemoglobin level was seen to be 2%....Table 1.
Autosomal recessive congenital methemoglobinemia is an inherited condition that mainly affects the function of red blood cells.
The hallmark of methemoglobinemia is cyanosis unresponsive to high-flow oxygen in the absence of cardiac or pulmonary disorders. Acutely developing methemoglobinemia is infrequently encountered in clinical practice. Several drugs used in surgery and medicine can cause methemoglobinemia.
Cut off tip of tube. With a clean finger or swab apply an amount of gel the size of a green pea into the tooth cavity. Use up to 4 times daily. Do not use continuously.
Methemoglobinemia, or methaemoglobinaemia, is a condition of elevated methemoglobin in the blood. Symptoms may include headache, dizziness, shortness of breath, nausea, poor muscle coordination, and blue-colored skin (cyanosis).
The last in the direct line of Fugates to inherit the gene was Benjamin "Benjy" Stacy, whose skin at birth was "as Blue as Lake Louise," according to doctors at the time. He now lives in Alaska, according to Facebook.
Martin Fugate and Elizabeth Smith who had married and settled near Hazard, Kentucky, around 1820, were both carriers of the recessive methemoglobinemia (met-H) gene.
Troublesome Creek is a real place in Breathitt, Perry and Knott counties. The Pack Horse Library Project was a real effort to bring books to Eastern Kentucky between the years of 1935-1943.
Four types of local anesthetic have been reported as possibly causing methemoglobinemia: prilocaine, benzocaine, lidocaine, and tetracaine.
Specifi c local anesthetics used routinely in dentistry , most notably prilocaine and benzocaine, have a propensity to cause methemoglobinemia.
Many topical anesthetic sprays such as CETACAINE (benzocaine 14%, tetracaine 2%) and HURRICAINE (benzocaine 20%) have been implicated in cases of methemoglobinemia, a serious and sometimes fatal adverse drug reaction.
This product is used to temporarily relieve pain from minor mouth problems (such as canker sores, sore gums/throat, mouth/gum injury). Benzocaine is a local anesthetic that works by numbing the painful area.