Mahir Christopher, Bean Christopher, Fuzaylov Gennadiy
UMass Chan Medical School, Department of Anesthesia and Perioperative Medicine, 55 N Lake Ave, Worcester, MA 01655, United States.
Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit Street, Boston, MA 02114, United States.
J Surg Case Rep. 2025 Jun 16;2025(6):rjaf334. doi: 10.1093/jscr/rjaf334. eCollection 2025 Jun.
This case report presents a patient with acquired methemoglobinemia due to unlabeled local anesthetic use. Some local anesthetics disrupt oxidative phosphorylation in erythrocytes, forming methemoglobin, which cannot transport oxygen. A 10-year-old boy with 60% total body surface area flame burns experienced sudden deterioration on Day 6 in the pediatric intensive care unit, presenting with cyanosis, tachycardia, hypotension, and SpO2 of 76% on room air, improving to 90% on 100% FiO2. A telemedicine consultation was requested, and evaluation revealed an elevated methemoglobin level of 22%. The source was an inadequately labeled ointment containing prilocaine used for burn wound care. This case underscores the importance of vigilant monitoring when using local anesthetics on pediatric burn patients. Additionally, global telemedicine played a crucial role in the timely diagnosis and management of this rare but life-threatening condition.
本病例报告介绍了一名因使用未标明成分的局部麻醉剂而导致获得性高铁血红蛋白血症的患者。一些局部麻醉剂会破坏红细胞中的氧化磷酸化过程，形成无法运输氧气的高铁血红蛋白。一名10岁男孩全身60%体表面积被火焰烧伤，在儿科重症监护病房第6天突然病情恶化，出现发绀、心动过速、低血压，在室内空气中SpO2为76%，吸入100%氧气时升至90%。请求进行远程医疗会诊，评估显示高铁血红蛋白水平升高至22%。病因是用于烧伤伤口护理的一种含丙胺卡因但标签标注不充分的药膏。该病例强调了在儿科烧伤患者中使用局部麻醉剂时进行密切监测的重要性。此外，全球远程医疗在这种罕见但危及生命的疾病的及时诊断和管理中发挥了关键作用。
