Acquired Methemoglobinemia in an Infant: Consequence of Prolonged Application of Eutectic Mixture of Local Anesthetics (EMLA) Cream for Spontaneous Abscess Drainage

Kadri, Abdullah; Eldos, Yazeed; AlAnsari, Khalid M

doi:10.7759/cureus.31304

Cited by 2 publications

(1 citation statement)

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“…Symptoms reported included lethargy, cyanosis, and cardiopulmonary instability. Other common causes reported in children include application prior to catheter insertion or punctation [ 9 – 12 ]; omission of removing EMLA cream, long duration of application [ 11 , 12 ]; molluscum contagiosum removal [ 13 – 17 ]; underlying skin conditions with an impaired skin barrier such as eczema [ 13 , 16 ]; other small interventions, such as allergy skin testing, including application over an extensive area of skin [ 18 ]; and accidental ingestion of EMLA cream, resulting in status epilepticus in a 25-month-old child [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Systemic Toxicity Caused by Topical Application of EMLA Cream on a Leg Ulcer: Case Report and Review of Literature

Hoffmann,

Hartmann,

Nieratschker

et al. 2024

Dermatol Ther (Heidelb)

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Introduction Systemic toxicity of eutectic mixture of local anesthetics (EMLA) cream is rare and is most commonly observed in children, for example, upon extensive application, and rarely occurs in adults with certain dispositions. Case Report We report the case of a 71-year-old man who developed methemoglobinemia and systemic intoxication upon topical application of EMLA cream for leg ulcer and stasis dermatitis prior to surgical debridement. Approximately 45 min after application, the patient was found to be in a somnolent state, was unable to articulate, and showed peripheral cyanosis. The blood concentration of methemoglobin (MetHb) was 15.1%, and therefore, a diagnosis of systemic toxicity of EMLA due to methemoglobinemia was established. After removal of the cream, oxygen was applied, and further observation revealed that the patient’s condition rapidly improved without any residue. In the following, we also discuss literature related to systemic EMLA intoxication. Conclusion EMLA cream may cause severe systemic toxicity even in adults under certain conditions, for example, when applied on damaged skin or in extensive amounts.

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