title: Methemoglobinemia in postchemotherapy stomatitis topical treatment: 2 pediatric cases.
abstract: Methemoglobinemia is a rare congenital or acquired disease of increased blood methemoglobin concentration. We documented 2 cases of children suffering from neuroblastoma whose postchemotherapy anemia, leucopenia, and stomatitis were complicated by methemoglobinemia after using a formulary oral gel (7.5% benzocaine, doxycycline, nystatin, glycerin). The complication resulted in hospital treatment. Percutaneous oxygen saturation remained at 85% and 87% despite administration of 100% oxygen through a nonrebreather mask. Arterial blood gas analysis showed an oxygen saturation of 98% and 97%, respectively. Spectroscopic measurement showed methemoglobin concentration of 42% and 35.5%, respectively. After red blood cell transfusion and oral ascorbic acid in case 1 and methylene blue in case 2, the patients' condition improved. Although the benzocaine gel is not in use in several medical systems, it should be considered as a possible reason for methemoglobinemia.
authors: Department of Hematology, Oncology and Endocrinology, Medical University of Gdansk, Poland. bakaczor@gumed.edu.pl
authors: Barbara
authors: B
authors: Kaczorowska-Hac
authors: Joanna
authors: J
authors: Stefanowicz
authors: Teresa
authors: T
authors: Stachowicz-Stencel
authors: Marta
authors: M
authors: Kozlowska
authors: Elzbieta
authors: E
authors: Adamkiewicz-Drozynska
authors: Anna
authors: A
authors: Balcerska
mesh_terms: D000287:Administration, Topical; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000009:adverse effects; D001566:Benzocaine / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D004318:Doxycycline / Q000008:administration & dosage; D004338:Drug Combinations; D005782:Gels; D005990:Glycerol / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000188:drug therapy; D008297:Male; D008708:Methemoglobinemia / Q000139:chemically induced* / Q000503:physiopathology; D009447:Neuroblastoma / Q000188:drug therapy; D009761:Nystatin / Q000008:administration & dosage; D013280:Stomatitis / Q000139:chemically induced / Q000188:drug therapy*; D009396:Wilms Tumor / Q000188:drug therapy
chemical_list: D000779:Anesthetics, Local; D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000970:Antineoplastic Agents; D004338:Drug Combinations; D005782:Gels; D009761:Nystatin; D004318:Doxycycline; D005990:Glycerol; D001566:Benzocaine