Work

Unlabeled topical anesthetic-induced severe methemoglobinemia in a pediatric burn patient

Year: 2025

Type: article

Abstract: This case report presents a patient with acquired methemoglobinemia due to unlabeled local anesthetic use. Some local anesthetics disrupt oxidative phosphorylation in erythrocytes, forming methemoglobin, which cannot transport oxygen. A 10-year-old boy with 60% total body surface area flame burns experienced sudden deterioration on Day 6 in the pediatric intensive care unit, presenting with cyanosis, tachycardia, hypotension, and SpO2 of 76% on room air, improving to 90% on 100% FiO2. A telemedicine consultation was requested, and evaluation revealed an elevated methemoglobin level of 22%. The source was an inadequately labeled ointment containing prilocaine used for burn wound care. This case underscores the importance of vigilant monitoring when using local anesthetics on pediatric burn patients. Additionally, global telemedicine played a crucial role in the timely diagnosis and management of this rare but life-threatening condition.

Source: Journal of Surgical Case Reports

DOI: 10.1093/jscr/rjaf334

Authors: Christopher Mahir, Christopher Bean, Gennadiy Fuzaylov

Institutions: University of Massachusetts Chan Medical School, Massachusetts General Hospital

Language: English

Topic: Methemoglobinemia and Tumor Lysis Syndrome

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,000