Baby Orajel

Hi Moms,

I cut and pasted the email below from an acquantaince of my sister. I have never used any of this stuff, and I hear that some people swear by it, but I thought I would pass along the information.

Love, Ada
_____________________

Dear all,
I hope everyone is enjoying their summer. Some of you already know,
but we wanted to make everyone aware of a terrifying experience that we
had over the weekend. Thank g-d, everything's ok now but we thought
friends and family would want to be aware and would want to advise others with babies
Zane's been teething pretty badly for the past few days, and we
decided to give him Baby Orajel on Sunday afternoon. We've given it to him a
few times previously, when his first two teeth cut through, and never had a problem. Scott and I were both sitting with Zane on the floor
in his room when I rubbed a dosage on his upper gum. Seconds after I
gave it to him, he made a face as if he were crying but no noise came out.
I picked Zane up and he immediately went limp in my arms and his face
turned blueish. He was not panicking or gasping for air - he was lifeless. This lasted for approximately 15 seconds, but felt like an
eternity. Words cannot convey our feelings during that time (or even
now, ever) as we attempted to revive our son. No parent should ever
experience such a feeling and no person should ever see something like
this happen to a loved one. Without a doubt it was the scariest
moment of our lives. Ultimately, Zane "came to" and began to cry
hysterically. Thank g-d!!!!!!!! We spent the evening at the hospital, where Zane underwent numerous tests, all of which came back normal. We also spoke with Zane's
pediatrician, who stated that she advises against the use of this
product because its purpose is to numb and if it gets into an infant's
throat, it may stop them from breathing. Obviously, we wanted to
learn more about this product and why this happened so we conducted some
internet research. Interestingly, we came across some postings of
parents with similar experiences. Further, one website listed a side
effect as, "difficulty breathing and grey/blueish face." Also, when
we called Zane's daycare to let them know what happened, the owner said
that she's heard of this happening before. It's surprising then that
no such warning is on the bottle and that more people do not discuss the
negative and possible deadly implications of the use of this product. We don't want to imagine what could've happened if we had given this
to him at night, in his crib, as we (and many others) have done in the
past, and then walked away (although, of course we monitor him
throughout the night). To reiterate, the reason we share the above with you is to strongly advise you to throw away any Baby Orajel products you have at home and
please advise your friends and family of the same. Trust us, it's not worth the possible side effects.
Best,
Scott and Allison

Hi Moms, My good friend Jessica forwarded this email on to her ER doc husband her he found the information below for me. It's a little technical, so I have pasted Dr. Ray's "bottom line" info below. Very scary stuff. Feel free to pass on to those with teething kids. Love, Ada

Please let parents know that this stuff can be very dangerous even with first use. Over the counter does not mean safe. I can not tell you how often this reaction
occurs but there is a treatment for it. If at any time
this occurs, tell moms and dads to go directly to the ER and bring the product with them.
If anyone would like more information about any product...remember your poison control center.


*********************************************************************

> Oral anesthetic gels
>
> Relative Contraindication: INFANTS < 6 MONTHS OLD AT
> HIGHER RISK FOR DEVELOPING METHEMOGLOBINEMIA.
>
> what METHEMOGLOBINEMIA is: Background
>
> Red blood cells contain 4 hemoglobin chains. Each
> hemoglobin molecule is composed of 4 polypeptide chains
> associated with 4 heme groups. The heme group contains an
> iron molecule in the reduced or ferrous form (Fe2+). In
> this form, iron can combine with oxygen, by sharing an
> electron, to form oxyhemoglobin. When oxyhemoglobin
> releases oxygen to the tissues, the iron molecule is
> restored to its original ferrous state. Hemoglobin can
> accept and transport oxygen only when the iron atom is in
> its ferrous form. When hemoglobin becomes oxidized, it is
> converted to the ferric state (Fe3+) or methemoglobin.
> Methemoglobin lacks the electron that is needed to form a
> bond with oxygen and, thus, is incapable of oxygen
> transport. Because red blood cells are continuously exposed
> to various oxidant stresses, blood normally contains
> approximately 1% methemoglobin levels.
>
> This low level of methemoglobin is maintained by 2
> important mechanisms. One protective mechanism against
> oxidizing agents is the hexose-monophosphate shunt pathway
> within the erythrocyte. Through this pathway, oxidizing
> agents are reduced by glutathione prior to the formation of
> methemoglobin. The second and more important mechanism
> against methemoglobin formation uses 2 enzyme systems,
> diaphorase I and diaphorase II. These 2 enzyme systems
> require nicotinamide adenine dinucleotide (NADH) and
> nicotinamide adenine dinucleotide phosphate (NADPH),
> respectively to reduce methemoglobin to its original
> ferrous state. Diaphorase II quantitatively contributes
> only a small percentage of the red blood cells reducing
> capacity. However, diaphorase II can be pharmacologically
> activated by exogenous cofactors (ie, methylene blue) to 5
> times its normal level of activity.
>
> Pathophysiology
>
> Oxidation of iron to the ferric state reduces the
> oxygen-carrying capacity of hemoglobin and produces a
> functional anemia. In addition, a ferric heme group affects
> nearby ferrous heme groups. Ferric heme groups impair the
> release of oxygen from nearby ferrous heme groups on the
> same hemoglobin tetramer. The result of methemoglobinemia
> is that oxygen delivery to tissues is impaired and the
> oxygen hemoglobin dissociation curve shifts to the left.
>
> Organs with high oxygen demands (ie, CNS, cardiovascular
> system) usually are the first systems to manifest toxicity.
> Oxygenated blood is red, deoxygenated blood is blue, and
> blood-containing methemoglobin is a dark reddish brown
> color. This dark hue imparts clinical cyanosis when
> methemoglobin levels are at 1.5 g/dL (approximately 10-15%
> methemoglobin concentration); however, a level of 5 g/dL of
> deoxygenated blood is required for similar effects.
> Therefore, when methemoglobin levels are relatively low,
> cyanosis may be observed without cardiopulmonary symptoms.
>
> Mortality/Morbidity
>
> As methemoglobin levels increase, patients demonstrate
> evidence of cellular hypoxia. Death occurs when
> methemoglobin fractions approach 70%. Death can occur at
> lower levels in patients with significant comorbidities.
>
> Age
>
> Children, especially those younger than 4 months, are
> particularly susceptible to methemoglobinemia.
> The primary erythrocyte protective mechanism against
> oxidative stress is the NADH system. In infants, this
> system has not fully matured, and the NADH methemoglobin
> reductase activity and concentrations are low.
>
> History
>
> Normal methemoglobin concentrations are 1% (range, 0-3%).
> At concentrations of 3-15%, a slight discoloration (eg,
> pale, gray, blue) of the skin may be present.
> At fractions of 15-20%, the patient may be relatively
> asymptomatic, but cyanosis is likely to be present.
> Signs and symptoms at fractions of 25-50% are as follows:
> Headache
> Dyspnea
> Lightheadedness
> Weakness
> Confusion
> Palpitations, chest pain
> Signs and symptoms at fractions of 50-70% are as follows:
> Altered mental status
> Delirium
> Physical
>
> Discoloration of the skin and blood is the most striking
> physical finding.
> Cyanosis occurs with the formation of 1.5 g/dL of
> methemoglobin, as compared to 5 g/dL of deoxygenated
> hemoglobin.
> Seizures
> Coma
> Dysrhythmias (eg, bradyarrhythmia, ventricular dysrhythmia)
> Acidosis
> Cardiac or neurologic ischemia
> Causes
>
> Compromised physiologic cellular defenses against oxidant
> stress occur in some patients, including the following:
> Children younger than 4 months may have underdeveloped
> protective mechanisms. Infections, especially GI
> infections, may cause a buildup of systemic oxidants by an
> overgrowth of gut bacteria.
> Congenital lack protective cellular capabilities includes
> those with the following:
> Patients with NADH methemoglobin reductase (diaphorase I)
> deficiency may develop congenital methemoglobinemia.
> Patients with hemoglobin M disease may have abnormal
> hemoglobin that is not amenable to reduction.
> Patients with pyruvate kinase deficiency may have an
> impaired glycolytic pathway, which results in deficient
> NADH production.
> Patients with G-6-PD deficiency may have impaired
> production of NADPH in the hexose-monophosphate shunt.
> Agents that inflict large oxidant stress on patients
> include the following:
> Pharmaceutical agents include local anesthetic agents (eg,
> BENZOCAINE, lidocaine, prilocaine), amyl nitrite,
> chloroquine, dapsone, nitrates, nitrites, nitroglycerin,
> nitroprusside, phenacetin, phenazopyridine, primaquine,
> quinones, and sulfonamides.
> Environmental agents include the following:
> Aniline dyes
> Aromatic amines
> Arsine
> Butyl nitrite
> Chlorates
> Chlorobenzene
> Chromates
> Combustion products
> Dimethyltoluidine
> Foods containing nitrates or nitrites (including well
> water)
> Isobutyl nitrite
> Naphthalene
> Nitroaniline
> Nitrobenzene
> Nitrofurans
> Nitrophenol
> Nitrosobenzene
> Resorcinol
> Silver nitrate
> Trinitrotoluene
>
>
> Baby oral gel contains: BENZOCAINE 10%
>
> Please let parents know that this stuff can be very
> dangerous even with first use. Over the counter does not
> mean safe. I can not tell you how often this reaction
> occurs but there is a treatment for it. If at any time
> this occurs, tell moms and dads to go directly to the ER
> and bring the product with them.
>
> If anyone would like more information about any
> product...remember your poison control center.
>
>
> V/R,
>
> Raymond