Definition
Methemoglobinemia can occur following use or prilocaine in adults. In adults, the toxic dose is ~ 600 mg IV. Prilocaine is metabolized by the liver to O-toluidine, which oxidizes hemoglobin (Fe2+) to methemoglobin (Fe3+). This can also occur with EMLA cream, especially in neonates 3 months or younger (although still safe in the vast majority of neonates). Treatment is with methylene blue
Methemoglobinemia and Prilocaine
- 600 mg maximal safe dose in adults
- Metabolic byproduct O-toluidine converts Fe2+ to Fe3+
- Treat with methylene blue
Subspecialty
Related Media
Keyword history
94%/2010
See Also:
Sources
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- Miller’s Anesthesia, 7th Edition. p 934-5
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- Lund P, Cwik J: Propitocaine (Citanest) and methemoglobinemia. Anesthesiology 53: 259, 1980