Hoffmann Sarah Marie, Hartmann Anna Luisa, Nieratschker Pablo, Mussler Michael Berthold, Schempp Christoph Mathis
Department of Dermatology, Medical Center, University of Freiburg, Hauptstrasse 7, 79104, Freiburg, Germany.
University Emergency Unit, Medical Center, University of Freiburg, Sir-Hans-A.-Krebs-Strasse, 79106, Freiburg, Germany.
Dermatol Ther (Heidelb). 2024 Apr;14(4):1057-1062. doi: 10.1007/s13555-024-01139-7. Epub 2024 Apr 3.
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.
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.
EMLA cream may cause severe systemic toxicity even in adults under certain conditions, for example, when applied on damaged skin or in extensive amounts.
局部麻醉药共熔混合物（EMLA）乳膏的全身毒性罕见，最常见于儿童，例如在大面积应用时，而在具有某些特殊体质的成年人中很少发生。
我们报告了一例71岁男性患者，在手术清创前，其腿部溃疡和淤积性皮炎局部应用EMLA乳膏后发生了高铁血红蛋白血症和全身中毒。应用乳膏约45分钟后，发现患者处于嗜睡状态，无法清晰表达，外周出现发绀。高铁血红蛋白（MetHb）的血浓度为15.1%，因此，确诊为因高铁血红蛋白血症导致的EMLA全身毒性。去除乳膏后，给予吸氧，进一步观察发现患者病情迅速改善，未遗留任何后遗症。接下来，我们还讨论了与EMLA全身中毒相关的文献。
即使在某些情况下，例如在受损皮肤或大面积应用时，EMLA乳膏也可能导致成年人发生严重的全身毒性。
