| Methemoglobinemia Associated with Diarrheal Disease before 2 Months of Ag |
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Ji Ah Jung, Jung Won Lee, Jeong Wan Seo |
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Departmemt of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea |
| 생후 2개월 이전의 영아에서 설사와 동반된 메트헤모글로빈혈증 |
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정지아, 이정원, 서정완 |
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이화여자대학교 의과대학 소아과학교실 |
Correspondence:
Jeong Wan Seo, Email: jwseo@mm.ewha.ac.kr
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| Abstract |
Purpose
: Methemoglobinemia has been observed during a diarrheal illness among those who
were not exposed to oxidizing agents in neonates and young infants. We performed the study to
determine predisposing factors in this entity.
Methods
: The medical records of 24 patients were reviewed, who were admitted for diarrhea with
methemoglobinemia to Ewha Womans University MokDong Hospital, from February 1994 to November
2000. The concentration of methemoglobin was measured by CO-oximeter(ABL520Ⓡ, Radiometer,
Sweden).
Results
: All the patients were before 2 months of age, had poor weight gain and dehydration
associated with diarrhea. One patient was a breast feeding infant, 20 were bottle feeding, and 3
were mixed feeding. The seasonal variation in the incidence of the disease was indistinct but more
cases were found during the winter months. We observed cyanotic skin discoloration in 21
patients, vomiting in 13, lethargy in 13, fever in 9, decreased urine output in 8, tachypnea in 4,
and irritability in 2. The mean concentration of methemoglobin was 19.8¡¾14.6%(range 3.8-65.0%)
on admisssion. The severity of methemoglobinemia was significantly correlated with blood WBC
(r=0.506, P=0.012), arterial blood pH(r=-0.600, P=0.002), total CO2 concentration(r=-0.456, P=0.025)
and base excess(r=-0.429, P=0.036). The underlying diseases were milk allergy(8 patients), sepsis
(2), urinary tract infection(1), salmonellosis(1), viral meningitis(1) and unknown(11). The majority
of patients were treated conservatively and 9 patients(37.5%) were treated with intravenous administration
of methylene blue.
Conclusion
: This study suggested that diarrhea, acidosis, infection and dehydration may be certain
predisposing roles for developing methemoglobinemia in neonates and young infants. We
should consider checking methemoglobin concentration in patients with diarrhea and cyanosis. |
| Key Words:
Methemoglobinemia, Diarrhea, Acidosis, Dehydration, Infant, Neonate |
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