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When Prilocaine, an anesthetic, is administered, exceeding the maximum recommended dose can lead to methemoglobinemia. This condition occurs when there is an abnormal amount of methemoglobin in the blood, a form of hemoglobin that cannot effectively carry oxygen. Symptoms may include cyanosis (a bluish discoloration of the skin), fatigue, and in severe cases, it can lead to significant health risks, such as hypoxia.

The physiological mechanism underlying methemoglobinemia is that Prilocaine can oxidize the iron in hemoglobin from the ferrous (Fe2+) to the ferric (Fe3+) state, resulting in methemoglobin formation. This can interfere with oxygen delivery to tissues, prompting a need for intervention.

On the other hand, while an allergic reaction, heart arrhythmia, and stroke are potential risks associated with anesthetic agents, they are not primarily linked to the overdosage of Prilocaine specifically in the same direct manner as methemoglobinemia. Allergic reactions can happen with any medication and often are not dose-dependent, heart arrhythmias typically arise from systemic effects rather than a specific overdose of Prilocaine, and strokes are related to various vascular issues that are less directly