1162

Abstract

Introduction: Although topical anesthetic toxicity is a frequent cause of methemoglobinemia in infants, it is exceptionally rare in children and must be expeditiously diagnosed and treated to avoid morbidity and mortality. Here we present the case of a 4-year old with molluscum contagiosum and eczema who presented to the dermatologist after application of 45mg of EMLA (1125mg lidocaine) to 80% of the 0.72m2 body surface area. The patient developed seizures and methemoglobinemia within an hour of application. Upon arrival to the intensive care unit, she had a mild metabolic acidosis, was dusky appearing, and had saturations in the mid 80's that were unresponsive to oxygen therapy. The initial methemoglobin level was 30.2%. The patient was treated with a single dose of 2mg/kg of methylene blue, with a subsequent level of 3.2% obtained 90 minutes later, with improvement in saturations and clinical appearance. Topical anesthetics are routinely prescribed for home application prior to outpatient dermatologic procedures. These agents have a narrow therapeutic window, and due to a high surface area to mass ratio and presence of skin conditions that may increase systemic absorption (i.e. eczema), the pediatric intensivist should be aware of complications associated with these agents.