title: Severe methemoglobinemia linked to gel-type topical benzocaine use: a case report.
abstract: BACKGROUND
  Methemoglobinemia is an uncommon cause of tissue hypoxia, but it can be life threatening if it is not identified and treated promptly.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Over-the-counter topical benzocaine should be used with caution, and the presence of methemoglobinemia must be promptly identified and treated.
authors.affiliation: Department of Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, New York 11212, USA.
authors.forename: Nam-Young
authors.initials: NY
authors.lastname: Chung
authors.forename: Rajni
authors.initials: R
authors.lastname: Batra
authors.forename: Myrzia
authors.initials: M
authors.lastname: Itzkevitch
authors.forename: Donna
authors.initials: D
authors.lastname: Boruchov
authors.forename: Mary
authors.initials: M
authors.lastname: Baldauf
mesh_terms: D000287:Administration, Topical; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects*; D001566:Benzocaine / Q000008:administration & dosage / Q000009:adverse effects*; D002675:Child, Preschool; D003490:Cyanosis / Q000188:drug therapy / Q000209:etiology*; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005782:Gels; D006801:Humans; D008297:Male; D008708:Methemoglobinemia / Q000139:chemically induced*; D008751:Methylene Blue / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D004791:Enzyme Inhibitors; D005782:Gels; D008751:Methylene Blue; D001566:Benzocaine