title: [Toxic methemoglobinemia].
abstract: METHODS
  A 19 year-old female patient suffered from severe hypoxemia after an ambulant surgery for splayfeet. Local anesthesia had been performed with prilocain and bupivacain. Methemoglobinemia was suspected and treated with ascorbine acid and methylene blue. The patient was then admitted to hospital.
  
  
  METHODS
  The patient was well orientated and awake. She complained of a mild headache and general illness. There was marked central cyanosis. A blood sample was dark-red to brownish. The periphere oxygen saturation was 85%. A cardiac ultrasound and a chest X ray were without pathological findings.
  
  
  METHODS
  Initial arterial blood gas analysis showed a concentration of methemoglobin of 24%. On intensive care clinical and laboratory findings quickly resolved and methemoglobin concentration normalized after one day. The patient had no symptoms anymore and was discharged the next day.
  
  
  CONCLUSIONS
  In treatment-resistent hypoxemia after local anesthesia toxic methemoglobinaemia should be suspected. Therapy of choice is immediate administration of methylene blue.
authors.affiliation: Medizinische Klinik, EVK Düsseldorf, Germany. philbender@web.de
authors.forename: P
authors.initials: P
authors.lastname: Bender
authors.forename: H
authors.initials: H
authors.lastname: Neuhaus
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D002045:Bupivacaine / Q000009:adverse effects*; D003422:Critical Care; D003937:Diagnosis, Differential; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D005532:Foot Deformities, Congenital / Q000601:surgery; D006801:Humans; D000860:Hypoxia / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D008706:Methemoglobin / Q000032:analysis; D008708:Methemoglobinemia / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D008751:Methylene Blue / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy; D011183:Postoperative Complications / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D011318:Prilocaine / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D004791:Enzyme Inhibitors; D011318:Prilocaine; D008706:Methemoglobin; D008751:Methylene Blue; D002045:Bupivacaine