Published online May 2, 2005
PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1452 (doi:10.1542/peds.2005-0285)

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Benzocaine: Not Dangerous Enough?

Diane P. Calello, MD
Allison A. Muller, PharmD
Fred M. Henretig, MD
Kevin C. Osterhoudt, MD, MSCE
Poison Control Center and Children's Hospital of Philadelphia
Phildelphia, PA 19107

To the Editor.—

We recently cared for an 11-month-old child who drank up to 2 mL of a 20% benzocaine anesthetic teething gel, which was believed to be cherry-flavored acetaminophen. He was admitted to our institution for tachycardia (200 beats per minute, on average), which resolved over 24 hours, but otherwise suffered no untoward effects, including methemoglobinemia.

However, we were surprised to find that the potential poison was in a nonchildproof container.

The toxicity of benzocaine and has been well described and includes the potential for life-threatening and severe methemoglobinemia.^1,2 While fatalities are rare, they do occur.³ For this reason, benzocaine is cited by multiple authors as a drug that can be lethal to children in small doses.^4,5

Yet the Poison Prevention Act of 1970, which regulates which substances require childproof packaging, currently leaves benzocaine off the list.⁶ Other topical anesthetics (lidocaine and dibucaine) are included. Although benzocaine toxicity is milder than that from these other anesthetics, the potential for life-threatening consequences of ingestion still exists and has been reported. We believe that this policy should be amended, that poison-prevention packaging should be required for benzocaine, and that pediatricians should counsel parents as to the potential hazard of these anesthetic teething gels.

This report was also filed with the US Consumer Product Safety Commission.

REFERENCES

1. Gilman CS, Veser FH, Randall D. Methemoglobinemia from a topical oral anesthetic. Acad Emerg Med. 1997;4 :1011 –1013[Medline]
2. Gentile DA. Severe methemoglobinemia induced by a topical teething preparation [published correction appears in Pediatr Emerg Care. 1988;4:164]. Pediatr Emerg Care. 1987;3 :176 –178[Medline]
3. Moore TJ, Walsh CS, Cohen MR. Reported adverse event cases of methemoglobinemia associated with benzocaine products. Arch Intern Med. 2004;164 :1192 –1196[Abstract/Free Full Text]
4. Osterhoudt KC. The toxic toddler: drugs that can kill in small doses. Contemp Pediatr. 2000;3 :73 –88
5. Liebelt EL, Shannon MW. Small doses, big problems: a selected review of highly toxic common medications. Pediatr Emerg Care. 1993;9 :292 –297[Medline]
6. US Consumer Product Safety Commission. Poison prevention packaging: a textbook for pharmacists and physicians. Washington DC: US Consumer Product Safety Commission; 1999. Available at: www.childrelatedresearch.com/library/ppp_text_for_pharm_and_phys.pdf. Accessed March 17, 2005

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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Calello, D. P. Articles by Osterhoudt, K. C. Search for Related Content PubMed PubMed Citation Articles by Calello, D. P. Articles by Osterhoudt, K. C. Related Collections Therapeutics & Toxicology Social Bookmarking                         What's this?