Méthémoglobinémie après application de crème Emla® chez un enfant : circonstances et conséquences d’un surdosage

Schmitt, C.; Matulic, M.; Kervégant, Morgane; Tichadou, Lucia; Boutin, A.; Glaizal, Mathieu; Haro, Luc de

doi:10.1016/j.annder.2012.06.035

Cited by 8 publications

(4 citation statements)

References 14 publications

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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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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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“…The majority of cases of acquired methemoglobinemia described in literature have resulted from exposure to exogenous oxidizing agents like nitrites used as preservatives in food or as a deliberate poison,[34] amyl nitrate used as a recreational agent,[56] abuse of paint thinner by addicts,[7] intake of nitrate containing vegetables[8] use of EMLA cream,[910] and Dapsone intake. [1112]…”

Section: Discussionmentioning

confidence: 99%

Dapsone-induced methemoglobinemia: "Saturation gap"-The key to diagnosis

Singh

Sethi

Pandith

et al. 2014

J Anaesthesiol Clin Pharmacol

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“…In addition, the topical anesthetic Emla (lidocaine plus prilocaine) has been recently reported as a cause of methemoglobinemia in infants and children. 11,12 Also, potentially fatal methemoglobinemia has been reported in patients with a deficiency of G-6-phosphate dehydrogenase (G6PD) who received rasburicase, a recombinant version of urate oxidase enzyme used to prevent and treat tumor lysis syndrome. 13,14 Lastly, methemoglobinemia has been reported in patients with inflammatory bowel disease treated with mesalamine.…”

Section: ■ What Is Methemoglobinemia and What Causes It?mentioning

confidence: 99%