A Case of Infantile Methemoglobinemia

Abstract

Methemoglobinemia is a disease developing as a result of oxidation of iron in hemoglobin from Fe+2 to Fe+3 and causing cyanosis due to inadequate oxygen transport to tissues. We present a 36-day-old patient who developed cyanosis after receiving local anesthesia, with the intention to draw attention to the risk of secondary methemoglobinemia caused by local anesthetics in small children. A 36-day-old male patient developed cyanosis following achillotomy operation. The level of methemoglobinemia was 27.2% (N: 0-2%). The patient received oxygen therapy by a face mask and intravenous ascorbic acid. Cyanosis regressed and the methemoglobin level dropped to 1.5% at the 12th hour of treatment, thus, he was discharged. In patients with a blood methemoglobin level above 20%, oxygen therapy by a face mask and ascorbic acid and methylene blue therapies are used. Infants and prematures are more sensitive to oxidizing agents since erythrocyte NADH-cytochrome b5 reductase levels are nearly half of those in advanced ages. The risk of methemoglobinemia increases among infants younger than one year of age. Local anesthetic agents should be used in the lowest effective dose in infants younger than one year of age, and risk of methemoglobinemia should be kept in mind.

Keywords

• Baby
• local anesthetic
• methemoglobinemia