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[Methaemoglobinaemia after using EMLA cream]
Jasper L Selder1, Jan Veenstra
1Sint Lucas Andreas Ziekenhuis, afd. Interne geneeskunde, Amsterdam, the Netherlands. j.selder@slaz.nl
Nederlands Tijdschrift Voor Geneeskunde
|July 18, 2013
Summary
Excessive use of EMLA cream can cause methemoglobinemia, a serious condition affecting oxygen levels. Blood gas analysis is crucial for diagnosis when pulse oximetry may be unreliable.
Area of Science:
- Dermatology
- Toxicology
- Emergency Medicine
Background:
- Topical anesthetics like EMLA cream are generally safe but can cause systemic side effects.
- Laser hair removal is a common cosmetic procedure.
Observation:
- A 22-year-old woman presented with dyspnea, confusion, and cyanosis after using excessive EMLA cream for laser hair removal.
- Her oxygen saturation was critically low (87%) by pulse oximetry, with high methemoglobin (met-Hb) levels (19%) on blood gas analysis.
Findings:
- The patient's condition was diagnosed as methemoglobinemia, likely induced by excessive topical lidocaine/prilocaine absorption.
- Spontaneous resolution of methemoglobinemia occurred, obviating the need for specific treatment like methylene blue.
Implications:
- Overapplication of EMLA cream, especially with compromised skin integrity, can lead to significant methemoglobinemia.
- Pulse oximetry is unreliable for assessing oxygen saturation in cases of methemoglobinemia; blood gas analysis is essential for accurate diagnosis.
