Prilocaine
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Prilocaine Methaemoglobinaemia: case report
A 42-year-old woman developed methaemoglobinaemia following administration of prilocaine for bone marrow biopsy. The man with a history of pancytopenia and familial mediterranean fever was admitted to the emergency department with a chief complaint of dyspnoea. Prior to current admission, she had undergone bone marrow biopsy following administration of prilocaine [route and dosage not stated] for assessment of the cause of pancytopenia. Approximately 6h following the procedure, she developed shortness of breath and bluish discoloration of the hands and lips. Her medical history included familial mediterranean fever for 30 years for which she had been receiving colchicum. She was non-alcoholic and non-smoker. At the current admission, her vital signs were found as follows: temperature 36.6°C, heart rate 68 beats/min, BP 90/60mm Hg, respiratory rate 36 breaths/min and oxygen saturation by pulse oximetry 78% in room air. Physical examination showed cyanosis in the fingertips and perioral area. Her heart sounds were normal with clear lungs. ECG findings revealed a normal sinus rhythm. No abnormalities were observed on the chest X-ray. Her neurological evaluation was intact. Due to low BP and oxygen saturation, the woman was initiated on sodium-chloride [saline] infusion and oxygen treatment. Subsequent investigations showed haemoglobin 13.2 g/dL, lactate 1.8 mEq/L and methaemoglobin level 34.9%. The complete blood count findings were consistent with pancytopenia as follows: haemoglobin 8.7 g/dL, leukocyte count, 3.02 × 103 /µL and thrombocyte count, 62.6 × 103 /µL. Biochemical laboratory tests were found to be normal except for elevated CRP levels. Based on presenting symptoms and methaemoglobin level, a diagnosis of prilocaine-induced methaemoglobinaemia was made [duration of treatment to reaction onset not stated]. Therefore, she was treated with methylthioninium-chloride [methylene blue] and an infusion of ascorbic-acid [vitamin C]. Despite respiratory support, her cyanosis persisted, and the undersea and hyperbaric medicine department was consulted which suggested hyperbaric oxygen treatment. Eventually, after the initiation of the methylthioniniumchloride treatment, her dyspnea and cyanosis were resolved. Repeated methaemoglobin level was found to be 2%. Thereafter, she was referred to the hyperbaric oxygen treatment clinic for the continuation of follow-up and treatment. Medetalibeyoglu A, et al. Prilocaine-Induced Methemoglobinemia. Case Reports in Acute Medicine 3: 25-28, No. 2, 2020. Available from: URL: http:// doi.org/10.1159/000508403
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Reactions 5 Dec 2020 No. 1833
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