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[Acquired methemoglobinemia: a case report]
Insights
Methaemoglobinemia in infants can cause severe cyanosis and a lavender skin color. It is often induced by nitrates in contaminated water or vegetable broths used in infant formulas.
Area of Science:
- Pediatrics
- Toxicology
- Clinical Medicine
Background:
- Methaemoglobinemia is a rare blood disorder where hemoglobin is oxidized to methaemoglobin, reducing oxygen transport.
- In infants, nitrate contamination in water or certain vegetables (spinach, carrots) used in formulas is a common cause.
Observation:
- Infants present with severe cyanosis, a distinctive lavender skin hue, and chocolate-brown blood.
- Symptoms arise from consuming powdered formula mixed with nitrate-rich vegetable broths.
Findings:
- Diagnosis involves excluding other cyanosis causes and spectrophotometric analysis for methaemoglobin levels.
- Levels above 60% can lead to coma and death; methylene blue is an effective treatment.
Implications:
- Highlights the risk of nitrate-contaminated infant foods and the importance of early diagnosis.
- Emphasizes prompt treatment with methylene blue for severe cases of infant methaemoglobinemia.
Abstract:
When an infant presents severe cyanosis which is not associated with respiratory distress, methaemoglobinemia should always be suspected. In children its main inducers are contaminated water or vegetable broths with high nitrate levels (especially spinach and carrots) used to prepare powdered formula or soups. Children affected with methaemoglobinemia have a peculiar lavender colour. Blood from the heel sticks is chocolate-brown and does not become pink when exposed to room air. Diagnosis can be confirmed by excluding other causes of cyanosis and by spectrophotometric analysis of blood for methaemoglobin. When methaemoglobin's levels reach 60% or more, the patient will collapse and become comatose and may die. Therapy with methylene blue results in prompt relief. In this article we report a case of methaemoglobinemia due to the administration of powdered formula mixed with vegetable broths to a newborn aged 16 days. Furthermore we will present a short review of literature regarding methaemoglobinemia caused by toxic agents over the last 10 years.