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Transient Methemoglobinemia with Acidosis in Newborn

Journal of the Korean Pediatric Society 1994;37(3):416-421.
Published online March 15, 1994.
Transient Methemoglobinemia with Acidosis in Newborn
Heng Mi Kim
Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
산혈증과 동반한 신생아 methemoglobin 혈중 5례
경북대학교 의과대학 소아과학교실
methemoglobinemia is an uncommon clinicl problem generally caused by inherited disorders of hemoglobin metabolism or environmental toxicity from oxidizing agents. Since methemoglobin has no oxigen carrying capacity, patient with severe methemoglobinemia may have dangerous hypoxia even when arterial oxygen tension is normal. Degree of exposure to oxidants which are benign for older individuals may produce severe methemoglobinemia in newborns. Acidosis without oxidants may also produce methemoglobinemia. Fetal hemoglobin has increased susceptibility to oxidation. NADH diaphorase activity is reduced to 60% of adult levels in newborn erythrocytes. Low pH further reduces the activity of the enzyme. We report our experience with 5 unrelated newborns, ranging in age from 9 to 33 days, who presented with diarrhea, dehydration, acidosis and transient methemoglobinemia. No history of toxin exposure could be elicited. On admission, all patients weighted less than their birth weights. All were mild to severely dehydrated, acidotic and methemoglobin levels ranged from 14.7% to 49.1%. In one cases Pseudomonas aeruginosa was isolated in the stool Rehydration and correction of acidosis were done. Three of them were trated with 2mg/kg of methylene blue and improved immediately. Two patient improved without methylene blue injection. Methemoglobinemia under acidosis may be a common phenomenon in newborn period.
Key Words: Transient methemoglobinemia, Acidosis, Dehydration, Newbonr

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