Is threshold for treatment of methemoglobinemia the same for all? A case report and literature review

The American Journal of Emergency Medicine
Amr El-Husseini, Nick Azarov

Abstract

Acquired methemoglobinemia (MetHb) is a rare complication of exposure to toxic chemicals or drugs, most commonly topical anesthetic agents. This condition occurs when the rate of methemoglobin production exceeds the rate of methemoglobin reduction. Topical anesthetics have been reported to cause MetHb, but this adverse event is extremely rare and is not usually listed as one of the possible complications of transesophageal echocardiography (TEE). However, the number of published case reports of TEE-associated MetHb has recently increased. Benzocaine (ethyl aminobenzoate) is a topical anesthetic widely used for oropharyngeal anesthesia before TEE. Health care providers who are not familiar with the association of TEE and benzocaine-induced MetHb may not recognize the idiosyncratic and often nonspecific characteristics of this condition. Recognition is critical, as clinically important symptoms may occur at relatively low MetHb levels. If left untreated, MetHb can lead to cardiopulmonary compromise, severe neurologic impairment, and even death. The current report documents a case of TEE-associated MetHb from a high-volume (3000 cases per year including 300-350 TEEs per year) echo laboratory. Our patient was symptomatic and severe...Continue Reading

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Citations

May 23, 2013·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Mohammed TalebJodi Tinkel
May 15, 2013·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Michael D Jain, Anna Nikonova
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Oct 22, 2015·Journal of Community Hospital Internal Medicine Perspectives·Raju KhanalRichard Alweis
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Jun 7, 2011·American Journal of Therapeutics·Anna Skold, Robin Klein
Nov 15, 2019·Headache·Fawad Ahmed KhanAlexander Maslov
Apr 2, 2014·Proceedings·Aasim AfzalJohn Schwartz
Dec 7, 2020·Pediatric Transplantation·Aditi HindkaPriya S Verghese
Feb 1, 2015·The Journal of the American Osteopathic Association·Mark BarashDennis Rademaker
Feb 25, 2021·Journal of Pediatric Hematology/oncology·Emna BouatrousHouyem Ouragini

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