ABSTRACT 591

Abstract

Background and aims: Methemoglobinemia is an uncommon cause of cyanosis. It is characterized by varying degrees of cyanosis due to increased hemoglobin concentrations containing oxidized iron. Acquired methemoglobinemia is caused by some drugs especially local anesthetics, some foods or water containing high levels of nitrate, and infections. Aims: Although prilocaine can cause severe methemoglobinemia in infants even in therapeutic doses, it is still widely used local anesthetic as a routine part of ambulatory circumcision procedures in Turkey. We aim to discuss this rare but potentially lethal complication of local anesthetics in infants and its treatment strategies. Methods: We report a case that presented with cyanosis and was diagnosed methemoglobinemia after receiving local anesthesia with prilocaine. Results: A 32 days old male was referred to our hospital with cyanosis which appeared 2 hours after circumcision. He had received local prilocaine during the procedure. In physical examination, no abnormality was detected except central cyanosis and restlessness. His past medical history was unremarkable. His oxygen saturation level was 88% despite of supplemental oxygen. In laboratory, blood methemoglobin level was 32%. He was treated with intravenous ascorbic acid. The methemoglobin level was decreased to 8.4% in 12th hour and 1.9% in 24th hour of the treatment. 72 hours after surgery, he was discharged from the hospital without any complication. Conclusions: Methemoglobinemia can be life-threatening. It should be included in differential diagnosis of infants presenting with acute cyanosis. Prilocaine should not be used in infants especially less than 3 months because of the risk of methemoglobinemia.