Local anesthetic: Methemoglobinemia
Last updated: 03/05/2015
Methemoglobinemia can occur following use orprilocainein adults. In adults, thetoxic dose is ~ 600 mg IV. Prilocaine is metabolized by the liver toO-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 withmethylene blue
Methemoglobinemia and Prilocaine
- 600 mg maximal safe dose in adults
- Metabolic byproduct O-toluidine converts Fe2+ to Fe3+
- Treat with methylene blue
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