A Man Drank Throat Numbing Spray While Eating Spicy Food. This Is What Happened To His Brain.

Patient RJ by Jake Rattan, Friend 1 by Matt Hernandez, Food Enjoyer by Lexi Richmond, PA/Friend 4 by Luke Menzies
Mark Rober Hot Ones: https://www.youtube.com/watch?v=CJbP71RI-V4
Peer Review: Dr Araceli Morga Vera, Dr Yue Wu, Dr Katherine Johns
Spanish translation and dub: Cenzontle Voices Inc, CDMX
Portugese translation and dub: George Frederico
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In-depth (podcast) channel @HemeReview
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0:00 Throat Numbing Spray Label
0:14 A Man Swallowed 1 Bottle Throat Numbing Spray While Eating Spicy Food
2:00 haha spray go glug 😳 glug
3:29 The emergency room 🚑 where we are now
4:10 Cyanosis and oxygen saturation
5:05 Arterial blood gas vs oxygen saturation
5:58 ...but something's wrong
6:38 This brings us back to the spray...
7:16 I promise you that stuff you learned in high school chemistry was worth it because it applies here
10:07 What does the throat numbing spray have to do with this?
12:10 ONOO😞- (Biochemical breakdown)
14:49 Throat numbing spray misuse isn't new
15:52 When you misuse the antidote and it becomes a poison itself

Some images by Getty Images

These cases are patients who I, or my colleagues have seen. They are de-identified and many instances have been presented in more depth in an academic setting. These videos are not individual medical advice and are for general educational purposes only. I do not give medical advice over the internet.

References:
Benzocaine-induced Methemoglobinemia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1586795/

Reported Adverse Event Cases of Methemoglobinemia Associated With Benzocaine Products. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/217060

Safety Information on Benzocaine-Containing Products. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/safety-information-benzocaine-containing-products

Benzocaine. https://www.cureus.com/articles/68795-a-rare-case-of-benzocaine-induced-methemoglobinemia

Continuous Methylene Blue Infusions for Treating Recurrent Methemoglobinemia. https://toxandhound.com/toxhound/refractory-methemoglobinemia/

Methemoglobinemia https://emcrit.org/ibcc/methemoglobinemia/

Pulse Oximetry https://emcrit.org/pulmcrit/pulse-oximetry/

Characterization of the methemoglobin forming metabolites of benzocaine and lidocaine. https://www.tandfonline.com/doi/abs/10.1080/00498254.2016.1196402

Identification of N-Hydroxy-para-aminobenzoic acid in a cyanotic child after benzocaine exposure. https://pubmed.ncbi.nlm.nih.gov/25211007/

A mitochondrial superoxide theory for oxidative stress diseases and aging. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306659/

4.2 Oxygen Binding: https://chem.libretexts.org/Bookshelves/General_Chemistry/Book%3A_Structure_and_Reactivity_in_Organic_Biological_and_Inorganic_Chemistry_(Schaller)/V%3A__Reactivity_in_Organic_Biological_and_Inorganic_Chemistry_3/04%3A_Oxygen_Binding_and_Reduction/4.02%3A_Oxygen_Binding

Benzocaine Label without Methemoglobinemia warning: https://fda.report/DailyMed/29890aa7-915a-46db-943d-a041d42f3637

Acute Phenol Poisoning: https://www.jstor.org/stable/27720955

Goldfrank's Toxicologic Emergencies 11th Edition Text

Methemoglobinemia. UpToDate. Accessed 01 Feb 2023.

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