Occult methemoglobinemia in a medically-complex child and the opportunity for pharmacist intervention in the pediatric population

Abstract

Background Methemoglobinemia is a rare, yet life-threatening disorder that occurs due to an accumulation of methemoglobin in the blood. The clinical presentation often includes dyspnea, cyanosis, and hypoxemia that shows little improvement with the administration of supplemental oxygen. Ester anesthetics, including benzocaine ,are among the most notorious agents for causing this condition in children. The United States (US) Food and Drug Administration (FDA) warns against the administration of benzocaine to those younger than two years old and urges manufacturers to add a statement regarding the development of methemoglobinemia to the packaging of any products containing this ingredient. Case Presentation The objective of this article is to summarize the unique constellation of signs and symptoms observed in a seven-year-old child subsequently diagnosed with benzocaine-induced methemoglobinemia. Additionally, we emphasize the value of utilizing pharmacists as part of an interdisciplinary team when caring for pediatric patients. Conclusion Providers should recognize that methemoglobinemia may occur in toddlers and children outside of the FDA’s specific age warning window and must keep a broad differential for patients presenting with respiratory distress.