Knutsen Ane Kühmstedt, Dunlop Oona, Jacobsen Dag, Glæserud Pernille, Wibetoe Grunde
Hjertemedisinsk avdeling, Oslo universitetssykehus, Ullevål.
Akuttmedisinsk avdeling, og, CBRNE-senteret, Oslo universitetssykehus.
Tidsskr Nor Laegeforen. 2025 Feb 4;145(2). doi: 10.4045/tidsskr.24.0399. Print 2025 Feb 11.
Drug-induced methaemoglobinaemia is a rare but relevant condition with distinct features.
A woman in her sixties developed syncope and hypoxia following an extensive dental procedure. In the emergency department, she was stable but had dark arterial blood and oxygen saturation (SpO2) of 88 %, refractory to oxygen therapy. Blood gas analysis confirmed a methaemoglobin level of 25 % (normal < 1 %), attributed to the administration of 378 mg of prilocaine during the dental procedure (recommended maximum dosage: 300 mg). Treatment with intravenous methylene blue led to rapid recovery, with reduction of methaemoglobin levels. She was discharged the following day in good health.
Methaemoglobin forms when the haemoglobin iron oxidises from its ferrous (Fe2+) to ferric (Fe3+) state, which cannot bind oxygen, often triggered by high doses of drugs like prilocaine.
药物性高铁血红蛋白血症是一种罕见但相关的病症，具有独特的特征。
一名60多岁的女性在进行广泛的牙科手术后出现晕厥和低氧血症。在急诊科，她情况稳定，但动脉血呈深色，氧饱和度（SpO2）为88%，吸氧治疗无效。血气分析证实高铁血红蛋白水平为25%（正常<1%），原因是在牙科手术期间使用了378毫克丙胺卡因（推荐最大剂量：300毫克）。静脉注射亚甲蓝治疗后迅速康复，高铁血红蛋白水平降低。她于次日健康出院。
当血红蛋白铁从亚铁（Fe2+）氧化为高铁（Fe3+）状态时会形成高铁血红蛋白，高铁血红蛋白无法结合氧气，这通常由高剂量的药物如丙胺卡因引发。
