A case of methemoglobinemia due to lidocaine prilocaine cream application for burns
Sevgi Büyükbeşe Sarsu1, Kamil Şahin2, Fatma Saraç3
1Gaziantep Çocuk Hastanesi, Çocuk Cerrahisi Kliniği, Gaziantep
2Haseki Eğitim ve Araştırma Hastanesi, Çocuk Kliniği, İstanbul
3Haseki Eğitim ve Araştırma Hastanesi, Çocuk Cerrahisi Kliniği, İstanbul
Keywords: Lidocaine-prilocaine cream, methemoglobinaemia, burns, childhood
Abstract
Burns are most common accidents seen during childhood and can be lethal. Methemoglobin is formed by oxidation of ferrous (Fe2+) heme to the ferric (Fe3+) state. Methemoglobinemia is a hematologic disease, characterized by cyanosis which is due to the prevention of sufficient oxygen transport to the tissues. It may occur owing to primary and secondary causes. In this a paper burned patient having secondary methemoglobinemia because of application of cream including lidocaine-prilocaine as a local anesthetic medicine is presented.
One year old male patient with cyanosis was admitted to emergency room where he was noticed to have burns which affected around 20% of the body localized at the lower limb. While cardiac and pulmonary pathologies were not found, diagnosis was achieved via a high serum methemoglobin level. Intravenous methylene blue and ascorbic acid were applied to the patient.
Burn patients due to application of local prilocain lidocaine may result in detrimental effects. Wide surface area applications especially in small children will increase the risk of methemoglobinemia. Local anesthetic creams should not be used in pediatric patients with burn. Complication of methemoglobinemia should be kept in mind while using either transdermal or subcutaneous local anesthetic use.