Idiosyncratic Reactions

Methemoglobinemia is an uncommon idiosyncratic reaction most notably to prilocaine and topical benzocaine.6‑10,20,21,34‑38 Their metabolites bind to hemoglobin and interfere with its oxygen-carrying capacity. Signs and symptoms usually appear 3 to 4 hours after exposure and may include cyanosis, fatigue, weakness, nausea, sedation, seizures, and coma. Young patients and those with congenital methemoglobinemia or glucose‑6‑phosphate deficiency are the most susceptible.

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