Sudden Onset of Life-Threatening Methaemoglobinaemia After Intake of Inappropriately Stored Vegetable (Collard Greens) Meal in a 2.5-Year-Old Child

Year 2015, Volume: 40 Issue: 2, 353 - 357, 28.09.2015

Özlem Yılmaz Ebru Keskin , Ayhan Yiğithan Mahmut Keskin

https://doi.org/10.17826/cutf.40142

Cited By: 1

Abstract

Acquired methaemoglobinaemia most commonly occurs due to intake of or contact to certain drugs, such as local anesthetics. However, intake of certain vegetables which are essential for a healthy diet may also cause methaemoglobinaemia due to their high nitrate or nitrite content, and prolonged and inappropriate storage after preparation of vegetable meals increases the risk. We present a 2.5-year-old girl with Down’s syndrome who presented with central cyanosis due to severe methaemoglobinemiae with a methaemoglobin level of 62% after intake of collard greens (Brassica oleracea var. acephala) soup. Although development of methaemoglobinaemia after food intake has been reported rarely before, recognition of this potentially life-threatening condition early in its course may be life-saving.

Keywords

Methaemoglobinaemia, vegetable intake, nitrate, nitrite

İki Buçuk Yaşındaki Bir Çocukta Uygunsuz Şartlarda Saklanmış Sebze (Kara Lahana) Tüketimi Sonrasında Yaşamı Tehdit Eden Methemoglobinemi

Abstract

Edinsel methemoglobinemi en sık olarak, lokal anestetik ilaçlar gibi belirli ajanların alımından ya da belirli ajanlarla temastan sonra görülmektedir. Ancak, sağlıklı bir beslenme için gerekli olan belirli sebzelerin alımından sonra da methemoglobinemi gelişebildiği bilinmektedir. Bu durum, özellikle yeşil yapraklı sebzelerle hazırlanan yemekler, uzun süreli olarak uygunsuz koşullarda saklanırsa ortaya çıkabilir. Sebzelerin yüksek nitrat ve nitrit içeriği, methemoglobinemi geliştirme potansiyellerinden sorumlu tutulmaktadır. Burada, kara lahana çorbası tüketiminden sonra ortaya çıkan methemoglobinemiye (methemoglobin oranı: %62) ikincil santral siyanoz gelişen 2,5 yaşındaki Down sendromlu bir kız çocuğunu sunmak istedik. Besin alımı sonrasında methemoglobinemi gelişimi nadir olarak bildirilmiş olmasına rağmen, yaşamı tehdit eden bu durumun erken dönemde tanınması ve tedavi edilmesi önemlidir.

Keywords

Methemoglobinemi, sebze tüketimi, nitrat, nitrit

References

• Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: Etiology, Pharmacology, and Clinical Management. Ann Emerg Med. 1999;34:646- 56.
• Guay J. Methemoglobinemia related to local anesthetics: a summary of 242 episodes. Anesth Analg. 2009;108:837-45.
• Prasad R, Singh R, Mishra OP, et al. Dapsone induced methemoglobinemia: Intermittent vs continuous intravenous methylene bluetherapy. Indian J Pediatr. 2008;75:245–7.
• Martinez A, Valverde FS, Gil F, et al. Methemoglobinemia induced by vegetable intake in infants in Northern Spain. J Pediatr Gastroenterol Nutr. 2013;56:573-7.
• Sanchez-Echaniz J, Benito-Fernández J, Mintegui- Raso S. Methemoglobinemia and consumption of vegetables in infants. Pediatrics. 2001;107:1024-8.
• Chan TY. Vegetable-borne nitrate and nitrite and the risk of methaemoglobinaemia. Toxicol Lett. 2011;200:107-8.
• Sankar J, Devangare S, Dubey NK. Survival with 98% methemoglobin levels in a school-aged child during the "festival of colors". Pediatr Emerg Care. 2013;29:1102-3.
• Kobayashi Y, Fukami T, Higuchi R, et al. Metabolic activation by human arylacetamide deacetylase, CYP2E1, and CYP1A2 causes phenacetin-induced methemoglobinemia. 2012;84:1196-206. 9. Babbitt CJ,
• Garrett JS. Diarrhea and
• methemoglobinemia in an infant. Pediatr Emerg
• Care. 2000;16:416-7.
• Sadeq M, Moe CL, Attarassi B, et al. Drinking water nitrate and prevalence of methemoglobinemia among infants and children aged 1-7 years in Moroccan areas. Int J Int J Hyg Environ Health. 2008;211:546- 54.
• Savino F, Maccario S, Guidi C, et al. Methemoglobinemia caused by the ingestion of courgette soup given in order to resolve constipation in two formula-fed infants. Ann Nutr Metab. 2006;50:368–71.
• Murone AJ, Stucki P, Roback MG, et al. Severe methemoglobinemia due to food intoxication in infants. Pediatr Emerg Care. 2005;21:536-8.
• Bryk T, Zalzstein E, Lifshitz M. Methemoglobinemia induced by refrigerated vegetable puree in conjunction with supraventricular tachycardia. Acta Paediatr. 2003;92:1214-5.
• Geffner ME, Powars DR, Choctaw WT. Acquired methemoglobinemia. West J Med. 1981;134:7-10.
• Keating JP, Lell ME, Strauss AW, et al. Infantile methemoglobinemia caused by carrot juice. See comment in PubMed Commons belowN Engl J Med..1973;288:824-6.