title: Methemoglobinemia Secondary to Topical Benzocaine Application to Gastrostomy Site.
abstract: Benzocaine is a common topical anesthetic that has the ability to induce methemoglobinemia (MetHgb) in large doses. We describe a 4-year-old girl who received a standard dose of topical benzocaine to her gastrostomy mucosa that resulted in rapid, severe MetHgb. She required intubation, mechanical ventilation, and multiple doses of methylene blue for treatment. The resultant tissue hypoxia from MetHgb caused profound confusion, cyanosis, and myocardial infarction. Although the patient did not sustain any permanent disability, this case demonstrates the need for emergency providers to rapidly identify and treat MetHgb to reverse tissue hypoxia and prevent long-term sequelae.
authors.affiliation: From the *Department of Emergency Medicine, Vanderbilt University Medical Center; †Department of Pediatric Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt; ‡Tennessee Poison Center, Vanderbilt University Medical Center; §Department of Pharmacy Practice, Lipscomb University College of Pharmacy; and ∥Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lipton
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Szlam
authors.forename: Kim
authors.initials: K
authors.lastname: Barker
authors.forename: John G
authors.initials: JG
authors.lastname: Benitez
mesh_terms: D000287:Administration, Topical; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D001566:Benzocaine / Q000008:administration & dosage / Q000009:adverse effects*; D002675:Child, Preschool; D005260:Female; D005774:Gastrostomy; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal; D008708:Methemoglobinemia / Q000139:chemically induced* / Q000628:therapy*; D008751:Methylene Blue / Q000627:therapeutic use*
chemical_list: D000779:Anesthetics, Local; D008751:Methylene Blue; D001566:Benzocaine