Bupropion/lidocaine/prilocaine/mixed amphetamine salts
- PDF / 170,568 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 31 Downloads / 179 Views
1 OS
Methaemoglobinaemia: case report A 23-year-old woman developed methaemoglobinaemia secondary to lidocaine/prilocaine toxicity following topical application of lidocaine/prilocaine in an overdose. The lidocaine/prilocaine was used as a local anaesthetic prior to a laser-assisted hair removal procedure. Additionally, the administration of mixed-amfetamine-salts and bupropion (medications that interfere with cytochrome P450) for attention deficit hyperactivity disorder and depression contributed in the development of methaemoglobinaemia [not all routes, dosages and durations of treatments to reactions onsets stated]. The woman, who had attention deficit hyperactivity disorder and depression, had been receiving mixed-amfetamine-salts [Adderall] and bupropion. She was transferred from an urgent care center to the emergency department (ED) due to lightheadedness and perioral cyanosis following a laser-assisted hair removal procedure. Three hours prior to the procedure (i.e. 6h prior to the ED presentation), a total of 150g of lidocaine/prilocaine [EMLA] cream (5 tubes, 30g per tube) was applied to her torso. Prior to onset of the procedure, excess lidocaine/prilocaine cream was removed. Approximately 5h after initial application of lidocaine/prilocaine cream, she developed palpitations, lightheadedness and perioral cyanosis, prompting her to go to an urgent care center that subsequently referred her to the emergency department (ED). Vital signs on presentation to the ED revealed the following: body temperature 36.7°C, HR 108 beats per minute, BP 116/72mm Hg and RR 18 breaths per minute. The oxygen saturation by pulse oximetry was 88% on room air. She received 15 L/min oxygen by nonrebreather mask and the oxygen saturation remained in the mid 80s. On examination, she was found to have perioral cyanosis and normal heart and lung sounds. Neurological examination was also grossly intact, including mental status examination. A 12-lead ECG showed a normal sinus rhythm without any abnormality. Her methemoglobin level obtained from blood assay was found to be 21.8%. The woman received treatment with methylene blue solution over 30 min with subsequent improvement of oxygen saturation to 94% on room air after completion of the treatment. Consequently, her perioral cyanosis and palpitations improved. She was discharged over 6h after the initial presentation. Lerner RP, et al. EMLA-induced methemoglobinemia after laser-assisted hair removal procedure. American Journal of Emergency Medicine 37: 2119 e1-2119 e2, No. 11, 803444690 Nov 2019. Available from: URL: http://doi.org/10.1016/j.ajem.2019.158415
0114-9954/20/1786-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 11 Jan 2020 No. 1786
Data Loading...
