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Local anesthetic: Methemoglobinemia

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