SEVERE METHEMOGLOBINEMIA AND HEMOLYTIC ANEMIA AFTER INGESTION OF BENZOCAINE-COATED COCAINE PACKETS: A CASE REPORT
DOI:
https://doi.org/10.56238/levv17n60-047Keywords:
Methemoglobinemia, Benzocaine, Hemolytic Anemia, Methylene Blue, Cocaine, Case ReportAbstract
Introduction: Acquired methemoglobinemia is a potentially fatal condition characterized by hemoglobin oxidation and consequent impairment of oxygen transport. Benzocaine is a local anesthetic with well-recognized oxidative potential, usually associated with methemoglobinemia after topical mucosal exposure, although unusual routes of exposure may also lead to severe and initially difficult-to-recognize presentations.
Objective: To report a case of severe methemoglobinemia and hemolytic anemia after intentional ingestion of multiple benzocaine-coated cocaine packets in the context of internal drug transport.
Case report: A previously healthy 17-year-old male was brought to the emergency department after ingesting multiple benzocaine-coated cocaine packets. He presented with pallor, marked jaundice, peripheral cyanosis, and peripheral oxygen saturation between 70% and 75%, despite supplemental oxygen and preserved ventilation. Arterial blood gas analysis showed elevated arterial oxygen partial pressure, whereas co-oximetry confirmed a methemoglobin level of 43.5%. The patient received two intravenous doses of methylene blue associated with ascorbic acid, with an initial decrease in methemoglobin levels; however, he developed laboratory rebound and progressive hemolytic anemia, requiring packed red blood cell transfusion. Abdominal computed tomography showed multiple intraluminal foreign bodies in the colon, sigmoid colon, and rectum, with no signs of perforation, pneumoperitoneum, or obstruction, and conservative management was adopted with progressive elimination of the packets.
Conclusion: Methemoglobinemia should be considered in patients with cyanosis, oxygen-refractory desaturation, and preserved arterial oxygen partial pressure. In cases involving ingestion of packets containing illicit drugs, adulterants or coating substances such as benzocaine may act as persistent sources of oxidative toxicity, favoring methemoglobinemia rebound and hemolysis.
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