Pharmacological and medicolegal evaluation of methemoglobinemia cases due to local anesthetic drugs
PDF (Turkish)

Keywords

Local anesthetic
Methemoglobinemia
Lidocaine

How to Cite

1.
ÇALIK AU, MUTLU E, BEŞKOÇ C. Pharmacological and medicolegal evaluation of methemoglobinemia cases due to local anesthetic drugs. Bull Leg Med. 2026;31(2):220-6. https://doi.org/10.17986/blm.1805

Abstract

Abstract

Methemoglobin is an oxidized form of hemoglobin that does not bind to oxygen. Increased levels in the blood can cause the clinical syndrome of methemoglobinemia. The etiology can be either congenital (defects in hemoglobin synthesis or metabolism) or acquired, often drug-induced. Local anesthetic drugs are often held responsible. In this study, five cases of methemoglobinemia following local anesthetic drug administration were examined in terms of the history of the event, duration of symptom onset, clinical symptoms, laboratory tests, and treatments applied. By reviewing the literature, the cases were interpreted, suggestions were made on issues that should be avoided, and it was aimed to draw the attention of the medical community about this side effect, which may lead to legal applications by the patient's relatives.

PDF (Turkish)

References

Barash M, Reich KA, Rademaker D. Lidocaine-induced methemoglobinemia: a clinical reminder. Journal of Osteopathic Medicine. 2015;115(2):94-8. DOI: 10.7556/jaoa.2015.020

Camp NE. Methemoglobinemia. Journal of Emergency Nursing. 2007;33(2):172-4. DOI: 10.1016/j.jen.2006.11.007

Skold A, Cosco DL, Klein R. Methemoglobinemia: pathogenesis, diagnosis, and management. South Med J. 2011;104(11):757-61. DOI: 10.1097/SMJ.0b013e318232139f

Finder RL, Moore PA. Adverse drug reactions to local anesthesia. Dental Clinics. 2002;46(4):747-57.DOI: 10.1016/s0011-8532(02)00018-6

Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: etiology, pharmacology, and clinical management. Annals of emergency medicine. 1999;34(5):646-56. DOI: 0.1016/s0196-0644(99)70167-8

Erkuran MK, Duran A, Kurt BB, Ocak T. Methemoglobinemia after local anesthesia with prilocaine: a case report. American Journal of Emergency Medicine. 2015. DOI:10.1016/j.ajem.2014.09.021

Guay J. Methemoglobinemia related to local anesthetics: a summary of 242 episodes. Anesthesia & Analgesia. 2009;108(3):837-45. DOI: 10.1213/ane.0b013e318187c4b1

Bayat A, Kosinski RW. Methemoglobinemia in a newborn: a case report. Pediatric Dentistry. 2011;33(3):252-4.

Doko Y, Iranami H, Fujii K, Yamazaki A, Shimogai M, Hatano Y. Severe methemoglobinemia after dental anesthesia: a warning about propitocaine-induced methemoglobinemia in neonates. Journal of anesthesia. 2010;24:935-7. DOI: 10.1007/s00540-010-1004-4

Karavelioğlu A, Şen TA. Lokal Prilokaine Bağlı Methemoglobinemi: Olgu Sınumu. GümüşhaneÜniversitesi Sağlık Bilimleri Dergisi. 2012;1(4):304-8.

Wilder RT. Local anesthetics for the pediatric patient. Pediatric Clinics of North America. 2000;47(3):545-58. DOI: 10.1016/s0031-3955(05)70225-x

Caudill L, Walbridge J, Kuhn G. Methemoglobinemia as a cause of coma. Annals of Emergency Medicine. 1990;19(6):677-9. DOI: 10.1016/s0196-0644(05)82476-x

Kumar AR, Dunn N. Methemoglobinemia associated with a prilocaine-lidocaine cream. Clinical Pediatrics. 1997;36(4). DOI: 10.1177/000992289703600410

Duncan PG, Kobrinsky N. Prilocaine-induced methemoglobinemia in a newborn infant. The Journal of the American Society of Anesthesiologists. 1983;59(1):75-6. DOI: 10.1097/00000542-198307000-00015

Patch fop. Utah medicaid dur report october 2021. 2021.

Nusstein JM, Drum M, Khan AA. Pain Control. Cohen's Pathways of the Pulp: South Asia Edition E-Book. 2020:162.

Hegedus F, Herb K. Benzocaine-induced methemoglobinemia. Anesthesia progress. 2005;52(4):136-9. DOI: 10.2344/0003-3006(2005)52[136:BM]2.0.CO;2

Sambrook P, Smith W, Elijah J, Goss A. Severe adverse reactions to dental local anaesthetics: systemic reactions. Australian dental journal. 2011;56(2):148-53. DOI: 10.1111/j.1834-7819.2011.01316.x

Vallurupalli S. Methemoglobinemia due to topical pharyngeal anesthesia during endoscopic procedures. Local and regional anesthesia. 2010:137-42. DOI: 10.2147/LRA.S12227

Karim A, Ahmed S, Siddiqui R, Mattana J. Methemoglobinemia complicating topical lidocaine used during endoscopic procedures. The American journal of medicine. 2001;111(2):150-3.DOI: 10.1016/s0002-9343(01)00763-x

Schroeder T, Dieterich HJ, Mühlbauer B. Methemoglobinemia after axillary block with bupivacaine and additional injection of lidocaine in the operative field. Acta anaesthesiologicascandinavica. 1999;43(4):480-2. DOI: 10.1034/j.1399-6576.1999.430419.x

Lui K, Chow Y. Safe use of local anaesthetics: prevention and management of systemic toxicity. Hong Kong Medical Journal. 2010;16(6):470.

Vasters F, Eberhart L, Koch T, Kranke P, Wulf H, Morin A. Risk factors for prilocaine-induced methaemoglobinaemia following peripheral regional anaesthesia. European journal of anaesthesiology. 2006;23(9):760-5. DOI: 10.1017/S0265021506000913

Mofenson HC, Caraccio TR, Miller H, Greensher J. Lidocaine toxicity from topical mucosal application: with a review of the clinical pharmacology of lidocaine. Clinical Pediatrics. 1983;22(3):190-2. DOI: 10.1177/000992288302200306

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2026 Ali Ulvi ÇALIK- Emre MUTLU- Caner BEŞKOÇ