title: Methemoglobinemia caused by the ingestion of courgette soup given in order to resolve constipation in two formula-fed infants.
abstract: Methemoglobinemia is not a rare condition arising from the exposure to hemoglobin-oxidizing agents such as nitrates-nitrites present in well water or vegetables. Infants < 3 months of age are more susceptible than adults because of lower amounts of a key enzyme, NADH-cytochrome b5 reductase, which converts methemoglobin back to hemoglobin. We report 2 infants, aged respectively 2 and 1 months, suffering from methemoglobinemia, fed with a formula that was reconstituted with a high concentration of courgette soup to resolve constipation. They developed a severe cyanosis with methemoglobinemia (respectively 30.4 and 27%) and were hospitalized and treated with methylene blue at 1%. After 12 h the syndrome was completely resolved. Home-prepared infant foods containing vegetables are potential causes of methemoglobinemia. It is important not to feed infants with vegetables having a high nitrate content (e.g., courgette, spinach, beets and green beans) to resolve constipation since, particularly in the first months of life, they may cause severe methemoglobinemia.
authors.affiliation: Dipartimento di Scienze Pediatriche e dell'Adolescenza, Università di Torino, Azienda Ospedaliera OIRM - S.ANNA, Torino, Italy. francesco.savino@unito.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Savino
authors.forename: Stefano
authors.initials: S
authors.lastname: Maccario
authors.forename: Carla
authors.initials: C
authors.lastname: Guidi
authors.forename: Emanuele
authors.initials: E
authors.lastname: Castagno
authors.forename: Daniela
authors.initials: D
authors.lastname: Farinasso
authors.forename: Francesco
authors.initials: F
authors.lastname: Cresi
authors.forename: Leandra
authors.initials: L
authors.lastname: Silvestro
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Mussa
mesh_terms: D003248:Constipation / Q000178:diet therapy; D028464:Cucurbita / Q000009:adverse effects*; D003490:Cyanosis / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007225:Infant Food; D007231:Infant, Newborn; D008297:Male; D008708:Methemoglobinemia / Q000188:drug therapy / Q000209:etiology*; D008751:Methylene Blue / Q000627:therapeutic use; D009566:Nitrates / Q000378:metabolism; D009573:Nitrites / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D009566:Nitrates; D009573:Nitrites; D008751:Methylene Blue