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Methemoglobinemia in postchemotherapy stomatitis topical treatment: 2 pediatric cases

Barbara Kaczorowska-Hac1, Joanna Stefanowicz, Teresa Stachowicz-Stencel

  • 1Department of Hematology, Oncology and Endocrinology, Medical University of Gdansk, Poland. bakaczor@gumed.edu.pl

Journal of Pediatric Hematology/Oncology
|September 9, 2011
PubMed

Insights

Benzocaine oral gel can cause methemoglobinemia, a serious condition of increased methemoglobin in the blood. This rare complication requires prompt medical intervention, even in pediatric cancer patients.

Area of Science:

  • Pediatric Oncology
  • Hematology
  • Clinical Pharmacology

Background:

  • Methemoglobinemia is a rare condition characterized by elevated methemoglobin levels.
  • Neuroblastoma is a common pediatric cancer.

Observation:

  • Two children with neuroblastoma developed methemoglobinemia post-chemotherapy.
  • Symptoms included anemia, leucopenia, stomatitis, and critically low oxygen saturation despite supplemental oxygen.
  • The complication arose after using a topical oral gel containing benzocaine.

Findings:

  • Methemoglobin levels reached 42% and 35.5% in the affected children.
  • Percutaneous oxygen saturation readings were misleadingly low (85-87%).
  • Arterial blood gas analysis revealed accurate oxygen saturation (97-98%).

Implications:

  • Topical benzocaine formulations should be recognized as a potential cause of acquired methemoglobinemia.
  • Prompt diagnosis and treatment, including red blood cell transfusion and specific antidotes like methylene blue, are crucial.
  • Healthcare providers should maintain vigilance for methemoglobinemia in patients using benzocaine products, especially those with underlying conditions.

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