Food‐induced methemoglobinemia: A systematic review

Abstract

Methemoglobinemia is a sporadic, potentially fatal disease of poor tissue oxygenation in which ferrous hemoglobin (Fe2+) is oxidized to the ferric (Fe3+) state, rendering it incapable of binding oxygen (O2). Fortunately, it is diagnosable and treatable. Here, we present a systematic review of food‐induced methemoglobinemia. PubMed and Embase databases were searched using the term “methemoglobin*,” for articles up to December 31, 2020. Inclusion criteria were confirmed or probable cases of methemoglobinemia with an oxidant confirmed in food or body tissue samples, or the oxidant likely to have come from food. We found 97 articles describing 568 cases. Median age was 6 years (range: 2 weeks to 80 years). Median methemoglobin fraction was 30% (n = 142). Oxidizing agents were predominantly nitrites and nitrates. The commonest type of presentation was children eating vegetables (30%), followed by accidental ingestions (27%), and meat curing misadventures (22%). Favism was found to result in mild methemoglobinemia, highest fraction reported was 15.8%. Of the 35 deaths, 32 were from accidental ingestions (91%). In some fatal cases, diagnosis was likely delayed or missed, and antidote was not administered. The majority of cases survived, even with severe methemoglobin levels of up to 89%, provided that methylene blue was administered. Treatment with methylene blue alone resulted in an average methemoglobin drop of 39.1% (n = 22). Methemoglobinemia cases continue to occur due to accidental exposure, meat curing misadventures, and babies ingesting nitrate‐rich vegetables which have been inappropriately stored. Early recognition of the toxidrome, instituting antidote treatment, and notifying public health authorities are key to improved outcomes.

Enzyme mimetic electrochemical sensor for salivary nitrite detection using copper chlorophyllin and carbon nanotubes-functionalized screen printed electrodes

“…[(C target À C 0 )/C 0 ] Â 100 (6) where C target is the current signal (mA) of the nitrite concentration, and C 0 is the current signal (mA) of the CuCP-MWCNTs-SPCE without nitrite.…”

“…1 Nitrite levels in humans can be elevated as a result of nitrosative stress 2 and through the l -arginine/NO-synthase cascade. 3,4 Excessive levels of nitrite in humans can cause adverse effects, such as methemoglobinemia, 5–7 weakness, tachycardia (fast heart rate), fatigue/dizziness, and a risk of thyroid, 8,9 kidney, stomach and ovarian cancers. 9–12 Measurement of nitrite (NO 2 − ) levels in saliva samples offers a non-invasive approach to assess health conditions in humans.…”

Gases in Food Production and Monitoring: Recent Advances in Target Chemiresistive Gas Sensors

“…The use of ideal gas compositions also differs between the storage of fish and meat due to the presence of myoglobin in meat, an iron-containing protein that has a purple color and can react with oxygen gas molecules to form oxymyoglobin, which has a red color associated with fresh meat. However, if it largely reacts with oxygen, it forms methemoglobin [42], which is the brown color associated with spoiled food. Thus, it depends on the concentration of oxygen in the surrounding atmosphere.…”

Highly Sensitive Graphene-Based Electrochemical Sensor for Nitrite Assay in Waters

“…3 ), as a result of microorganisms in our saliva, stomach and intestines [9]. It has long been acknowledged that serious, harmful health consequences (such as respiratory distress, central nervous system problems, carcinogenic tumors, thyroid affections, genetic modifications, and even death) might occur from nitrite overexposure [10][11][12][13] High nitrite levels lead to a serious blood condition called methemoglobinemia or 'Blue Baby Syndrome', in which the body is deprived of oxygen, since nitrites oxidize the iron component of red blood cells (hemoglobin), causing them to lose their ability to transport oxygen [14]. In view of all of these health posing risks, the World Health Organization (WHO) has established guidelines on acceptable levels of human intake based on the lack of particular short-term health consequences (methemoglobinemia and thyroid effects).…”