{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:18:27Z","timestamp":1789154307344,"version":"build-2803163510"},"reference-count":13,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Klin Padiatr"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title>\n                  <jats:p>Wir berichten \u00fcber einen 8 Wochen alten S\u00e4ugling, der wenige Stunden nach\n                        operativer Achillotomie in Lokalan\u00e4sthesie aufgrund einer auff\u00e4lligen\n                        Hautfarbe ambulant vorgestellt wurde. Das Kind zeigte ein\n                        schmutzig-br\u00e4unliches, zyanotisches Hautkolorit bei reduziertem\n                        Allgemeinzustand mit einer Hypox\u00e4mie bei SaO2 84% ohne Besserung durch\n                        Sauerstoffvorlage. In der Blutgasanalyse zeigte sich eine Laktatazidose\n                        sowie ein deutlich erh\u00f6hter Meth\u00e4moglobinanteil von 38% (Norm\u22641,5%). Dies\n                        ist aufgrund des zeitlichen Zusammenhanges am ehesten auf die\n                        Infiltrationsan\u00e4sthesie mit Mepivacain zur\u00fcckzuf\u00fchren, welche zur\n                        Achillotomie durchgef\u00fchrt wurde. Es erfolgte eine Behandlung mit\n                        Methylenblau, hierunter kam es zu einer Restitutio ad integrum.<\/jats:p>\n                  <jats:p>Meth\u00e4moglobin entsteht durch Oxidation des im H\u00e4moglobin enthaltenen Eisens,\n                        wodurch keine Bindung von Sauerstoff mehr m\u00f6glich ist. Eine relevante\n                        Zyanose kann sich bei einem Meth\u00e4moglobinanteil von mehr als 10%\n                        manifestieren. Die Reduktion von Meth\u00e4moglobin zu Oxyh\u00e4moglobin durch das\n                        Enzym NADH-Cytochrom-b5-Reduktase ist physiologischerweise bei jungen\n                        S\u00e4uglingen nicht vollst\u00e4ndig ausgebildet. Zudem l\u00e4sst sich das H\u00e4moglobin\n                        von S\u00e4uglingen leichter oxidieren, was diese Kinder anf\u00e4llig f\u00fcr eine\n                        Meth\u00e4moglobin\u00e4mie macht. Das Blut f\u00e4rbt sich mit steigendem\n                        Meth\u00e4moglobinanteil braun, was klinisch und in Blutproben sichtbar ist.<\/jats:p>\n                  <jats:p>Lokalan\u00e4sthetika k\u00f6nnen bei kutaner und subkutaner Anwendung sowie bei\n                        Schleimhaut-Applikation eine klinisch relevante Meth\u00e4moglobin\u00e4mie\n                        verursachen, die eine schwerwiegende Hypox\u00e4mie zur Folge haben kann. Das\n                        Risiko hierf\u00fcr ist bei jungen S\u00e4uglingen erh\u00f6ht. Relevant ist das\n                        rechtzeitige Erkennen der Meth\u00e4moglobin\u00e4mie als Ursache f\u00fcr die Zyanose,\n                        welche gut behandelbar ist.<\/jats:p>","DOI":"10.1055\/a-2763-4491","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T23:56:21Z","timestamp":1768866981000},"page":"93-96","source":"Crossref","is-referenced-by-count":1,"title":["S\u00e4ugling mit Zyanose und Hypox\u00e4mie"],"prefix":"10.1055","volume":"238","author":[{"given":"Simone","family":"Nicolaus","sequence":"additional","affiliation":[{"name":"Allgemeine P\u00e4diatrie, Darmst\u00e4dter Kinderkliniken\n                    Prinzessin Margaret, Darmstadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ute Friederike","family":"Jarmola","sequence":"additional","affiliation":[{"name":"Kinderpneumologie, Darmst\u00e4dter Kinderkliniken\n                    Prinzessin Margaret, Darmstadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Becker","sequence":"additional","affiliation":[{"name":"Kinderpneumologie, Darmst\u00e4dter Kinderkliniken\n                    Prinzessin Margaret, Darmstadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.blre.2004.02.001","article-title":"Disorders of oxidised haemoglobin","volume":"19","author":"M J Percy","year":"2005","journal-title":"Blood Rev"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1002\/ajh.20738","article-title":"Methemoglobin \u2013 it's not just blue: a concise review","volume":"82","author":"J Umbreit","year":"2007","journal-title":"Am J Hematol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/j.annemergmed.2009.07.022","article-title":"A simple quantitative bedside test to determine methemoglobin","volume":"55","author":"F Shihana","year":"2010","journal-title":"Ann Emerg Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"622","DOI":"10.2471\/BLT.15.158147","article-title":"A bedside test for methemoglobinemia, Sri Lanka","volume":"94","author":"F Shihana","year":"2016","journal-title":"Bull World Health Organ"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1016\/s0196-0644(99)70167-8","article-title":"Methemoglobinemia: etiology, pharmacology, and clinical management","volume":"34","author":"R O Wright","year":"1999","journal-title":"Ann Emerg Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1213\/ane.0b013e318187c4b1","article-title":"Methemoglobinemia related to local anesthetics: a summary of 242 episodes","volume":"108","author":"J Guay","year":"2009","journal-title":"Anesth Analg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"394","DOI":"10.2165\/00002018-199614060-00005","article-title":"Drug-induced methaemoglobinaemia","volume":"14","author":"M D Coleman","year":"1996","journal-title":"Treatment issues. 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Akzidentelle Intoxikation bei\n                    einem Kleinkind mit Verbr\u00fchungen [Methemoglobin intoxication by prilocaine in\n                    EMLA. Accidental intoxication of an infant with scald injuries]","volume":"58","author":"A Book","year":"2009","journal-title":"Anaesthesist"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1080\/080352598750031202","article-title":"Methaemoglobin formation after the use of EMLA cream in term neonates","volume":"87","author":"M Brisman","year":"1998","journal-title":"Acta Paediatr"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e806","DOI":"10.1542\/peds.2005-1952","article-title":"Severe methemoglobinemia complicating topical benzocaine use during endoscopy in\n                    a toddler: a case report and review of the literature","volume":"117","author":"A Dahshan","year":"2006","journal-title":"Pediatrics"}],"container-title":["Klinische P\u00e4diatrie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2763-4491.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T23:48:31Z","timestamp":1772149711000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2763-4491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,19]]},"references-count":13,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2026,2,26]]},"published-print":{"date-parts":[[2026,2]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2763-4491","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0300-8630","1439-3824"],"issn-type":[{"value":"0300-8630","type":"print"},{"value":"1439-3824","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,19]]}}}