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Doctors from Providence, Rhode Island, recently reported the case of a 25-year-old woman whose blood had turned dark blue after taking a medication containing a common anesthetic agent.
The unnamed woman reportedly entered an emergency room in Rhode Island complaining of general weakness and fatigue, shortness of breath and a symptom that made even a seasoned medical staff do a double catch: she was visibly turning blue.
The doctors described the patient as "cyanotic", a clinical term referring to the blue and gray discoloration of the skin, attributed to the use of benzocaine, an active ingredient in over-the-counter medications and cold medicine.
"She said she used large amounts of topical benzocaine the night before to give herself a toothache," Drs. Otis Warren and Benjamin Blackwood, co-author of the recently published case study in the New England Journal of Medicine, have written.
Dr. Warren told CNN that he was able to properly diagnose the woman because he had the chance to see another cyanotic patient long ago during his residency. The case remained to him, and when he saw the "blue" woman, he knew exactly what to ask. The benzocaine she had used the previous night had triggered a rare reaction that caused a disease called methemoglobinemia.
"Methemoglobinemia can occur after exposure to a number of drugs, including topical anesthetics such as benzocaine, through metabolic pathways that appear to vary from one person to another, which can explain the unpredictability of this complication, "wrote the authors of the study.
Basically, benzocaine prevented the oxygen-rich blood from releasing oxygen into the tissues, which then caused the acquisition of a dark blue color. Interestingly, the only cure was also blue. According to Dr. Warren, Methylene blue returns a missing electron to the hemoglobin molecule that restores oxygen levels and helps release oxygen into the tissues. The patient received two doses of methylene blue and was monitored during the night. Her blood returned to normal and she was discharged with a dental referral.
"It's one of the few cases we've been taught, you're studying, you're testing, but you rarely see it," said Dr. Otis Warren.
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