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Incidence of subclinical methemoglobinemia in infants with diarrhea
1Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona.
Insights
Infants with diarrhea, especially those small for their age, face a significant risk of developing methemoglobinemia. Early screening for this condition is recommended in ill infants presenting with diarrhea.
Area of Science:
- Pediatrics
- Clinical Chemistry
Background:
- Diarrhea is a common pediatric illness.
- Methemoglobinemia is a rare but serious condition.
Observation:
- A prospective study of infants under 6 months with diarrhea revealed a high incidence of elevated methemoglobin.
- Infants with weight at or below the tenth percentile for age showed a strong correlation with methemoglobinemia development.
Findings:
- 64% of studied infants had elevated methemoglobin levels.
- No correlation was found between methemoglobinemia and acidosis, hyperchloremia, or positive microbiologic studies.
- Five patients required methylene blue treatment for methemoglobinemia, with full recovery.
Implications:
- Consider screening for methemoglobinemia in infants with diarrhea, particularly those who are small for their age.
- This finding highlights a greater-than-recognized risk in this vulnerable population.
Study Hypothesis:
Infants with diarrhea are at a greater-than-recognized risk of developing methemoglobinemia.
Design:
Prospective clinical study.
Setting:
A university hospital pediatric emergency department.
Participants:
Consecutive infants under 6 months of age with a history of diarrhea of more than 24 hours' duration not associated with vomiting.
Interventions:
Blood samples were obtained for methemoglobin (MHgb) assay (normal, 0.4% to 1.5%) and electrolytes. Treatment interventions were performed as clinically indicated. Patients with elevated MHgb levels subsequently underwent hemoglobin electrophoresis to exclude congenital methemoglobinemia.
Results:
Forty-three patients were studied; 27 (64%) had elevated MHgb levels and 13 were cyanotic. Five patients received infusions of methylene blue for methemoglobinemia. All patients recovered without sequelae. There was a strong correlation between weight at or below the tenth percentile for age and the development of methemoglobinemia. Contrary to previous studies, there was no correlation between incidence or severity of methemoglobinemia and acidosis, hyperchloremia, or positive microbiologic studies.
Conclusion:
In ill infants with diarrhea, particularly those who are small for age, consideration should be given to screening for methemoglobinemia.
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