{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T12:22:34Z","timestamp":1756902154074,"version":"3.44.0"},"reference-count":21,"publisher":"The Pediatric Pharmacy Association","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:p>Methemoglobinemia is a rare, yet life-threatening disorder that occurs due to an accumulation of methemoglobin in the blood. The clinical presentation often includes dyspnea, cyanosis, and hypoxemia that shows little improvement with the administration of supplemental oxygen. The US Food and Drug Administration (FDA) warns against the administration of benzocaine to those younger than 2 years of age and urges manufacturers to add a statement regarding the possible development of methemoglobinemia to the packaging of any products containing this ingredient. However, providers caring for pediatric patients should recognize that methemoglobinemia may occur in toddlers and children outside of the FDA\u2019s specific age warning window and must keep a broad differential for patients presenting with respiratory distress. The objective of this article is to highlight a case of a child subsequently found to have benzocaine-induced methemoglobinemia and emphasize the importance of pharmacists in an emergency medicine setting, particularly in the care of patients with uncommon acute conditions requiring lesser-known pharmacologic treatments.<\/jats:p>","DOI":"10.5863\/1551-6776-29.6.650","type":"journal-article","created":{"date-parts":[[2024,12,9]],"date-time":"2024-12-09T21:37:10Z","timestamp":1733780230000},"page":"650-653","source":"Crossref","is-referenced-by-count":0,"title":["Occult Methemoglobinemia in a Medically-Complex 7-Year-Old Child and the Opportunity for Pharmacist Intervention in Pediatric Emergency Medicine"],"prefix":"10.5863","volume":"29","author":[{"given":"Kendra L.","family":"Walsh","sequence":"first","affiliation":[{"name":"The Warren Alpert Medical School of Brown University (KLW), Providence, RI"},{"name":"Pharmacy Services, Hasbro Children\u2019s Hospital, Lifespan (KLW, CRS, PHL), Providence, RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian R.","family":"Silva","sequence":"additional","affiliation":[{"name":"Pharmacy Services, Hasbro Children\u2019s Hospital, Lifespan (KLW, CRS, PHL), Providence, RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick H.","family":"Lee","sequence":"additional","affiliation":[{"name":"Pharmacy Services, Hasbro Children\u2019s Hospital, Lifespan (KLW, CRS, PHL), Providence, RI"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3883","published-online":{"date-parts":[[2024,12,9]]},"reference":[{"unstructured":"Prchal\n              JT\n            \n          . Methemoglobinemia and other dyshemoglobinemias. In: KaushanskyK, PrchalJT, BurnsLJ, et al, eds.Williams Hematology , 10th ed.McGraw Hill; 2021. Accessed January 25, 2024. https:\/\/accessmedicine.mhmedical.com\/content.aspx?bookid=2962&sectionid=252529476","key":"2024121714202612000_i2331-348X-29-6-650-b01"},{"issue":"5","key":"2024121714202612000_i2331-348X-29-6-650-b02","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/S0196-0644(99)70167-8","article-title":"Methemoglobinemia: etiology, pharmacology, and clinical management","volume":"34","author":"Wright","year":"1999","journal-title":"Ann Emerg Med"},{"issue":"5","key":"2024121714202612000_i2331-348X-29-6-650-b03","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1007\/s12325-020-01282-5","article-title":"Methemoglobinemia in the operating room and intensive care unit: early recognition, pathophysiology, and management","volume":"37","author":"Cefalu","year":"2020","journal-title":"Adv Ther"},{"issue":"4","key":"2024121714202612000_i2331-348X-29-6-650-b04","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1097\/MJT.0000000000000028","article-title":"Ascorbic acid for the treatment of methemoglobinemia: the experience of a large tertiary care pediatric hospital","volume":"21","author":"Rino","year":"2014","journal-title":"Am J Ther"},{"issue":"2","key":"2024121714202612000_i2331-348X-29-6-650-b05","first-page":"140","article-title":"Two cases of methemoglobinemia: in a military community hospital","volume":"62","author":"Wall","year":"2016","journal-title":"Can Fam Physician"},{"issue":"7","key":"2024121714202612000_i2331-348X-29-6-650-b06","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1289\/ehp.00108675","article-title":"Blue babies and nitrate-contaminated well water","volume":"108","author":"Knobeloch","year":"2000","journal-title":"Environ Health Perspect"},{"key":"2024121714202612000_i2331-348X-29-6-650-b07","doi-asserted-by":"crossref","first-page":"23247096221117919","DOI":"10.1177\/23247096221117919","article-title":"A rare culprit of methemoglobinemia","volume":"10","author":"Fadah","year":"2022","journal-title":"J Investig Med High Impact Case Rep"},{"issue":"5","key":"2024121714202612000_i2331-348X-29-6-650-b08","doi-asserted-by":"crossref","first-page":"923","DOI":"10.5811\/westjem.2017.6.33665","article-title":"Pediatric exposures to topical benzocaine preparations reported to a statewide poison control system","volume":"18","author":"Vohra","year":"2017","journal-title":"West J Emerg Med"},{"unstructured":"US Food and Drug Administration. FDA Drug Safety Communication: FDA continues to receive reports of a rare, but serious and potentially fatal adverse effect with the use of benzocaine sprays for medical procedures. Published April 7, 2011. Accessed January 25, 2024. https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-drug-safety-communication-fda-continues-receive-reports-rare-serious-and-potentially-fatal","key":"2024121714202612000_i2331-348X-29-6-650-b09"},{"unstructured":"US Food and Drug Administration. FDA acts on OTC benzocaine oral products and RX local anesthetics. Published May 23, 2018. 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