scholarly journals Nosocomial Methemoglobinemia Resulting from Self-Administration of Benzocaine Spray

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Christopher Hoffman ◽  
Hawa Abubakar ◽  
Pramood Kalikiri ◽  
Michael Green
Keyword(s):  
Methylene Blue ◽  
Respiratory Distress ◽  
Nasogastric Tube ◽  
Clinical Presentation ◽  
Postoperative Recovery ◽  
Blood Gas ◽  
Self Administration ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Life Threatening

Methemoglobinemia is life-threatening and bears pathognomonic signs difficult to diagnose in real time. Local anesthetics are widely used and are known for eliciting this condition. We report a case of methemoglobinemia secondary to self-administered use of benzocaine spray. A 27-year-old woman was found to be in respiratory distress during postoperative recovery. After desaturation persisted, arterial blood gas yielded a methemoglobin level of 47%. The patient was successfully treated with intravenous methylene blue. Review of the events revealed self-administered doses of benzocaine spray to alleviate discomfort from a nasogastric tube. We review this case in detail in addition to discussing methemoglobinemia and its relevant biochemistry, pathophysiology, clinical presentation, and medical management. Given the recognized risk of methemoglobinemia associated with benzocaine use, we recommend its removal from the market in favor of safer alternatives.

scholarly journals Healthy blue man: congenital methemoglobinemia

2017 ◽  
Vol 5 (10) ◽  
pp. 4632
Author(s):  
B. V. Nagabhushana Rao ◽  
S. C. Sinha ◽  
S. Modi ◽  
S. Sunita
Keyword(s):  
Methylene Blue ◽  
Ascorbic Acid ◽  
Clinical Presentation ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Treatment Modalities ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis

Congenital methemoglobinemia, though often discussed in medical teachings is rarely encountered in clinical practice as the condition is asymptomatic. Here we present such a case and discuss in detail the clinical presentation of both congenital and acquired methemoglobinemia. We also outlined the management of the conditions. One should suspect methemoglobinemia when cyanosis is not being corrected by supplementing oxygen and and when the oxygen saturation is low by pulse oximetry and normal by arterial blood gas analysis. Treatment modalities for congenital methemoglobinemia is of cosmetic purpose, but timely intervention in acquired methemoglobinemia could be lifesaving. Methylene blue, Ascorbic acid and Riboflavin are drugs of choice.

Benzocaine Induced Methemoglobinemia a Potentially Life Threatening Complication after Transesophageal Echocardiogram

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4825-4825
Author(s):  
Shylendra B Sreenivasappa ◽  
Barbara Yim ◽  
R. Catchatourian
Keyword(s):  
Methylene Blue ◽  
Local Anesthesia ◽  
Medical Condition ◽  
Enzyme Level ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Transesophageal Echocardiogram ◽  
Arterial Blood ◽  
Life Threatening

Abstract Methemoglobinemia is a potentially life threatening medical condition that occurs due to increased methemoglobin production or decreased elimination. Methemoglobin is a derivative of hemoglobin in which the normal ferrous (Fe2+) iron state is oxidized to the ferric (Fe3+) state. This oxidized hemoglobin is unable to bind oxygen, hence reducing he oxygen carrying capacity of blood. The clinically presentation is characterized by cyanosis, low pulse oximeter reading and normal arterial PO2. Topical use of benzocaine a local anesthetic widely used in endoscopic procedures is one of the incriminated causes of acquired methemoglobinemia. We present two cases of patients (pts) who developed methemoglobinemia after benzocaine spray for a transoesophageal echocardiogram. One pt was 50 year old male and other 30 year old female. Both had a methacilline resistant Staphylococcus Aureus bacteremia secondary to septic arthritis, they under went a transesophageal echocardiogram to rule out endocarditis. Topical local anesthesia used was benzocaine 20%. About 10–15 min after local anesthesia they desaturated to the mid 80’s and they developed cynosis, they were intubated. On Blood gas analysis methemoglobin. was elevated 38.4% (male pt) and 18.9% (Female pt). They were given methylene blue at the dose of 2mg/kg intravenously over 10 minutes. Cyanosis corrected with in an hour. Methemoglobin level corrected to normal after 3 hours after administration of methylene blue. There were no adverse events with administration. The Glucose 6 Phosphate Dehydrogenase enzyme level was tested and was negative. In conclusion benzocaine induced methemoglobinemia should be considered in pts under going Transesophageal Echocardiogram when cyanosis develops that is unresponsive to oxygen. Diagnosis can be confirmed by arterial blood gas analysis. If identified early this potentially life threatening condition can be treated with methylene blue with minimal complications and good outcomes.

Computerized Ventilation

PEDIATRICS ◽  
1987 ◽  
Vol 79 (2) ◽  
pp. 315-316
Author(s):  
RAN D. ANBAR
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Trials ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
X Ray ◽  
Arterial Blood ◽  
Chest X Ray

To the Editor.— Carlo et al1 report an "expert system" based on an algorithm for mechanical ventilation of infants with respiratory distress syndrome which would have corrected arterial blood gas derangements in 89% of 106 clinical trials. This algorithm was applied to additional trials using an independently designed computer-generated ventilation simulation program (VSP). Written in BASIC, VSP expects its user to manage a randomly "created" infant with respiratory distress syndrome by monitoring arterial blood gas values, physical examination findings, and chest x-ray film findings.2

scholarly journals Interpretation of arterial blood gases

Pulse ◽  
1970 ◽  
Vol 3 (1) ◽  
pp. 15-19
Author(s):  
CP Dokwal
Keyword(s):  
Blood Gases ◽  
The Body ◽  
Respiratory Physiology ◽  
Blood Gas ◽  
Acid Base Balance ◽  
Acid Base ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Base Balance ◽  
Life Threatening

Measuring arterial blood gas is routinely performed in critically ill patients, and may unravel severe life-threatening acid-base disorders or hypoxemia. It provides the vital information about ventilation, oxygenation, and acid-base status in such persons. These three processes are intimately related to each other in achieving normal oxygenation and acid-balance in the body.The interpretation of arterial blood gas requires a reasonable understanding of respiratory physiology and acid-base balance in the body. Hence, in the following section, first the role of alveolar ventilation, oxygenation, and the maintenance of acid-base homeostasis have been discussed. This is followed by a step-wise approach to analyze the acid-base disorders, if present.DOI: 10.3329/pulse.v3i1.6547Pulse Vol.3(1) July 2009 p15-19

scholarly journals A Case Report of Prilocaine-Induced Methemoglobinemia after Liposuction Procedure

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Birdal Yildirim ◽  
Ulku Karagoz ◽  
Ethem Acar ◽  
Halil Beydilli ◽  
Emine Nese Yeniceri ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Emergency Service ◽  
Age Group ◽  
Shortness Of Breath ◽  
Blood Gas ◽  
Medicine Department ◽  
Arterial Blood Gas ◽  
Adult Age ◽  
Methemoglobin Level ◽  
Arterial Blood

Prilocaine-induced methemoglobinemia is a rarely seen condition. In this paper, a case is presented with methemoglobinemia developed secondary to prilocaine use in a liposuction procedure, and the importance of this rarely seen condition is emphasized. A 20-year-old female patient presented with complaints of prostration, lassitude, shivering, shortness of breath, and cyanosis. It was learned that the patient underwent nearly 1000 mg prilocaine infiltration 8 hours priorly during a liposuction procedure. At admission, her blood pressure (130/80 mmHg), pulse rate (140 bpm), body temperature (36°C), and respiratory rate (40/min) were recorded. The patient had marked acrocyanosis. The arterial blood gas methemoglobin level was measured as 40%. The patient received oxygen therapy with a mask and was administered vitamin C in normal saline (500 mg tid), N-acetylcysteine (300 mg tid), and 50 mg 10% methylene blue in the intensive care unit of the internal medicine department. Methemoglobin level dropped down to 2% after her treatment with methylene blue and she was clinically cured and discharged 2 days later. Emergency service physicians should remember to consider methemoglobinemia when making a differential diagnosis between dyspnea and cyanosis developing after prilocaine infiltration performed for liposuctions in the adult age group.

scholarly journals ARDS Case Treated With ECMO

2020 ◽  
Author(s):  
Elvan Tekir Yılmaz ◽  
Duygu Demiriz Gülmez
Keyword(s):  
Respiratory Distress ◽  
Blood Gas ◽  
Hypoxemic Respiratory Failure ◽  
Arterial Blood Gas ◽  
Cotton Wool Spots ◽  
Arterial Blood ◽  
Protective Ventilation Strategy ◽  
Tertiary Healthcare ◽  
Chest X Ray ◽  
Ecmo Treatment

Acute Respiratory Distress Syndrome (ARDS) is characterized with diffuse bilaterat radiologic infiltration, and a hypoxemic respiratory failure. A 48-year-old housewife hospitalized in a chest diseases hospital with the diagnosis of pneumonia was intubated for increased respiratory distress. The patient, who developed cardiac arrest three times underwent CRP for nearly 15 minutes. When she was admitted to intensive care unit of a tertiary healthcare institute, severe acidosis was detected in her first arterial blood gas sample (ph 6.9). Bilateral rales were heard in respiratory system auscultation and “cotton wool spots” were observed on her PA chest X-ray and initial diagnosis of ARDS was made. The patient was consulted with the department of infectious diseases, and zyvoxid 2x1 (avelox 1x1 meronem 2x1) were added to her antibiotherapy. The patient’s admission parameters were as follows: WBC 45000/mm3 CRP: 11 mg/dL sedimentation: 84 mg/dL. Although the patient was followed up on a mechanical ventilator with a protective ventilation strategy for 2 days, ECMO treatment was decided because PaO2 / FiO2 <100 and blood gas values did not improve. ECMO treatment was applied for 5 days. Then, the patient was extubated and transferred to the service without complications.

scholarly journals Benzocaine-Induced Methemoglobinemia: A Condition of which all Endoscopists Should Be Aware

2004 ◽  
Vol 18 (10) ◽  
pp. 625-629 ◽  
Author(s):  
C Armstrong ◽  
KW Burak ◽  
PL Beck
Keyword(s):  
Methylene Blue ◽  
Pulse Oximetry ◽  
Rare Complication ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Gas Sampling ◽  
Diagnosis And Management ◽  
Arterial Blood ◽  
Brown Colour ◽  
Patient’S Perception

Methemoglobinemia is a rare complication that can occur with the use of benzocaine-containing compounds. Two cases of methemoglobinemia are reported, and the pathophysiology and treatment of methemoglobinemia are reviewed. Both patients received topical 20% benzocaine spray before endoscopy. Immediately following the procedure, there was a reduction in O2saturation assessed by pulse oximetry that was refractory to O2therapy. Dramatic peripheral and central cyanosis developed. O2saturation measured by pulse oximetry ranged from 83% to 87% on O2by nasal prongs and 100% O2by a nonrebreathing mask. Both patients were mildly confused and one patient complained of a significant headache. The diagnosis of methemoglobinemia was considered and arterial blood gas sampling was performed. In both patients, the arterial blood had a chocolate brown colour. A methemoglobin level of 48% and 18% was noted in patient 1 and patient 2, respectively. Both patients were treated with methylene blue, resulting in a significant improvement with gradual normalization of their O2saturation within 10 min to 30 min. The use of benzocaine spray may not markedly alter the patient's perception of endoscopy and thus, the routine use of these agents should be questioned. If such agents are used, the physician must be aware of this association to prevent a delay in the diagnosis and management of this rare, but potentially lethal, condition.

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