Journal of Community Pharmacy Practice ISSN: 2799-1199 Vol : 01 , No.01 , Aug-Sept 2021 http://journal.hmjournals.com/index.php/JCPP Author(s) 2021.This is an Open Access Article distributed under the CC Copyright © The ) http://creativecommons.org/licenses/by/4.0/ BY license. ( 1 Pediatric intoxication inducing after dental pain management OTC Benzocaine product. DR. MUHI.N.SALMAN 1 , M.SC TOXICOLOGY 2 1,2 Baghdad college of medical sciences, baghdad. Iraq Abstract; Background; Methemoglobinemia is a rare disorder of the blood in which there is an increase in the proportion of hemoglobin present in the oxidized form (methemoglobin). It may be inherited, due either to a deficiency of methemoglobin reductase or to a structural abnormality of hemoglobin, or it may be acquired, usually secondary to exposure to drugs or chemicals that oxidize hemoglobin l. Administration of some local anesthetics such as benzocaine at large doses may lead to an acute effect of risk Methemoglobinemia.. Presentation ; A 6-years-old child was suffering from dyspnea, headache, and grayish in appearance. The patient was self-treating with an over-the-counter topical oral benzocaine. Treatment; The diagnosis of methemoglobinemia was made in conjunction with consultation with a medical toxicologist and treatment with oxygen and methylene blue as antidote was given 1mg/kg of 1% solution intravenously over 7minutes. The symptoms improved within 30 minutes and child felt markedly better within 1.5 hour. Conclusion; Methylene blue is the specific antidote, but should be reserved for more severe cases. 1. INTRODUCTION FDA issued a safety communication1 warning health professionals and consumers that OTC benzocaine products should not be used in infants and children younger than 2 years and should only be used in adults and children older than 2 years. FDA also urged manufacturers to add warnings to their products’ labels about benzocaine’s potential to cause methemoglobinemia,a serious condition that changes the transport of oxygen to body tissues.(1).These products carry serious risks and provide little to no benefits for treating oral pain, due to the significant safety risk of methemoglobinemia blue lips and nail beds. Acquired methemoglobinemia is typically caused by oxidativestress and many prescribed medications are strongly associated with inducing methemoglobinemia e.g., Lidocaine , Metoclopramide, Prilocaine, Amyl nitrite, Nitroglycerin, Nitroprusside, sulfamethoxazole [2, 3]. A very common presentation of this cyanotic illness is after a medical procedure, such as endoscopy or bronchoscopy,during which a liberal amount of local anesthetic, such as benzocaine spray or gel is used [2,4,5]. The reported maximum dose before inducing methemoglobinemia would be 15mgper kilogram for a 50 kg person [6].