The condition of carotenaemia is harmless but can lead t o the mistaken diagnosis of jaundice; it may also be a feature in hypothyroidism. A case of carotenaemia in a baby is reported, caused by an excess of carrots in his mixed feeds, and the diagnostic features are emphasised.Case report S.M. aged seven and a half months had been a full-term baby, delivered normally at a maternity hospital, with Apgars of 9 at 1 min and 10 at 5 min. His birth weight was 6 lb 12 oz (3.06 kg) and jaundice was not noted during the neonatal period. He was breast-fed and had been found t o be normal at the welfare clinic, which he attended regularly.At five months of age and weighing 1 7 lb (7.7 11 kg), the baby was introduced t o mixed feeding, on which he continued t o thrive. Two months later, however, his parents noticed that he was becoming pigmented, as if 'suntanned'. The discolouration was first noticed on his face but slowly spread to other parts of his body. As the child had not been exposed t o the sun, his parents consulted their family doctor, who referred the child to hospital.There the mother explained that she had heard that carrots 'stopped night blindness' and had therefore decided to wean him using carrot puree. She gave him a measured quantity of carrots daily (Y2 lb, 0.227 kg raw weight), which was divided amongst his meals of breast milk and rusk and encouragingly he seemed to enjoy this altered diet.On examination he was found to be a happy, healthy baby, who had reached his normal milestones. He had a generalised orangey pigmentation which spared the sclera and his urine was of normal colour. There were no other physical signs and his weight was 21 Ib (9.525 kg).The characteristic sign of this disorder is a bright orange (carroty) pigmentation of the mucosa and skin. The colour is especially dark in the horny layers of skin on the palms of the hands and the soles of the feet. Whilst this is a reliable sign in an adult it is of course absent in an infant. As the sclera are spared discolouration, this condition cannot be confused with jaundice in which the sclera are always affected.The diagnosis was confirmed in this baby by measuring his total carotenoids as 0-carotene. The reference range for total carotenoids is 0.9 -3.7 pmol/l and in him they were raised t o 17 pmol/l. His serum bilirubin was normal at 4 pmol/l (normal range 0 -17 pmol/l).
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