Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2023

Open Access 01-12-2023 | Cyanosis | Case report

Hemolysis and acquired methemoglobinemia associated with lidocaine and benzocaine topical application: a case report

Authors: Nasim Khajavirad, Ghazal Daftari, Mehrasa Raisi Jelodar

Published in: Journal of Medical Case Reports | Issue 1/2023

Login to get access

Abstract

Background

Topical anesthetics are commonly used over the counter, and one of the adverse effects of these medications is methemoglobinemia, which is a serious and life-threatening condition.

Case presentation

We describe a 25-year-old Persian male presenting with generalized weakness, dizziness, headache, and cyanosis. In addition, he had genital warts starting 3 weeks ago, which were self-treated with podophyllin, resulting in itching and pain. He used over-the-counter topical anesthetics, including benzocaine and lidocaine, to reduce the symptoms. According to the lab data, signs and symptoms of methemoglobinemia and hemolysis were diagnosed. Considering the hemolysis, ascorbic acid was used for treatment. The patient was discharged after 5 days with normal arterial blood gas and pulse oximetry and no signs and symptoms.

Conclusion

This case highlights that self-administration of some topical anesthetics may lead to potentially fatal conditions.
Literature
1.
Cortazzo JA, Lichtman AD. Methemoglobinemia: a review and recommendations for management. J Cardiothorac Vasc Anesth. 2014;28(4):1043–7.CrossRefPubMed
2.
Taleb M, Ashraf Z, Valavoor S, Tinkel J. Evaluation and management of acquired methemoglobinemia associated with topical benzocaine use. Am J Cardiovasc Drugs. 2013;13(5):325–30.CrossRefPubMed
3.
Faust AC, Guy E, Baby N, Ortegon A. Local anesthetic–induced methemoglobinemia during pregnancy: a case report and evaluation of treatment options. J Emerg Med. 2018;54(5):681–4.CrossRefPubMed
4.
Alanazi MQ. Drugs may be induced methemoglobinemia. J Hematol Thrombo Dis. 2017;5(3):1–5.
5.
Cefalu JN, Joshi TV, Spalitta MJ, Kadi CJ, Diaz JH, Eskander JP, et al. Methemoglobinemia in the operating room and intensive care unit: early recognition, pathophysiology, and management. Adv Ther. 2020;37(5):1714–23.CrossRefPubMedPubMedCentral
6.
Barash M, Reich KA, Rademaker D. Lidocaine-induced methemoglobinemia: a clinical reminder. J Am Osteopath Assoc. 2015;115(2):94–8.PubMed
7.
Nappe TM, Pacelli AM, Katz K. An atypical case of methemoglobinemia due to self-administered benzocaine. Case Rep Emerg Med. 2015;2015: 670979.PubMedPubMedCentral
8.
Wang S, Giannakopoulos H, Lowstetter J, Kaye L, Lee C, Secreto S, et al. Lack of methemoglobin elevations after topical applications of benzocaine alone or benzocaine plus tetracaine to the oral mucosa. Clin Ther. 2017;39(10):2103–8.CrossRefPubMed
9.
Hahn I-H, Hoffman RS, Nelson LS. EMLA®-induced methemoglobinemia and systemic topical anesthetic toxicity. J Emerg Med. 2004;26(1):85–8.CrossRefPubMed
10.
Lavergne S, Darmon M, Levy V, Azoulay E. Methemoglobinemia and acute hemolysis after tetracaine lozenge use. J Crit Care. 2006;21(1):112–4.CrossRefPubMed
11.
Mir WAY, Shrestha DB, Reddy VK, Gaire S, Verda L. A case report of acute transient encephalopathy following a trans-esophageal echocardiography. Cureus. 2021;13(10): e18580.PubMedPubMedCentral
12.
Riaz S, Kudaravalli P, Saleem SA, Heisig D. Methemoglobinemia: a life-threatening complication of topical pharyngeal anesthetics. Cureus. 2020;12(4): e7900.PubMedPubMedCentral
Metadata
Title
Hemolysis and acquired methemoglobinemia associated with lidocaine and benzocaine topical application: a case report
Authors
Nasim Khajavirad
Ghazal Daftari
Mehrasa Raisi Jelodar
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2023
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-023-03898-x

Other articles of this Issue 1/2023

Journal of Medical Case Reports 1/2023 Go to the issue

Case report

Refractory multisystemic sarcoidosis, a diagnosis and treatment challenge: a case report

Case report

Levothyroxine absorption test followed by directly observed treatment on an outpatient basis to address long-term high thyrotropin levels in a hypothyroid patient: a case report

Case report

Unilateral rete mirabile in multiple intracranial arteries

Case Report

Giant umbilical cord in a normal preterm infant: a case report and review of the literature

Case report

Infectious endocarditis caused by Bartonella henselae associated with infected pets: two case reports

Case report

The importance of intraoperative echocardiography in the early detection of mitral regurgitation as a postsurgical sequel of aortic valve replacement: a case report