Methemoglobinemia after local anesthesia with prilocaine: a case report.

Address for Correspondence: Halil Doğan, Department of Emergency, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey E-mail: [email protected] ©Copyright 2016 by Emergency Physicians Association of Turkey Available online at www.jemcr.org Introduction For erythrocytes, which contain hemoglobin, to carry oxygen to tissues, the iron content of hemoglobin should be in the form of a ferrous ion (Fe+2).Fe+2 of hemoglobin is oxidized to ferric iron (Fe) as a result of various oxidative stresses and methemoglobin is formed (1). Methemoglobin releasesoxygen (O2) less efficiently to tissues and causes tissue hypoxia (2). Methemoglobinemia may occur because of hereditary or acquired reasons. The acquired form is more common than the congenital form. Many chemical substances or drugs that cause methemoglobinemia have been reported, such as nitrites, sulfonamides, chloroquine, aminobenzenes, and some local anesthetics (2, 3). Prilocaine is an anesthetic agent widely and safely used as a local anesthetic. It is a rare cause of methemoglobinemia, which is an uncommon cause of cyanosis (3-5). In this report, the case of a healthy adult who developed methemoglobinemia after the administration of local prilocaine before toenail shootings and who was successfully treated with methylene blue and general supportive therapy is reported.