Lesson of the week: Methaemoglobinaemia associated with sodium nitrite in three siblings

Finan, Alan; Keenan, Peter; Donovan, Frances O’; Mayne, Philip; Murphy, John J.

doi:10.1136/bmj.317.7166.1138

Cited by 21 publications

(11 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The tissue nitrate levels in onions and carrots which were found in this study are comparable with the levels which were reported elsewhere (Menzer 1993;Finan et al 1998;ISO 1984). A study done in Esfahan-IRAN (Fall 1998to Summer 1999 showed that the mean of amount of nitrate in some similar vegetables was 76.3 ppm (personal communication).…”

Section: Discussionsupporting

confidence: 94%

See 1 more Smart Citation

The measurement of nitrate and nitrite content in carrots and onions sampled from central cities of Mazandaran State of Iran

Shokrzadeh

Shokravie

Saravi

2008

Toxicological & Environmental Chemistry

View full text Add to dashboard Cite

Vegetables are the major source of nitrates and nitrites in human diet. Because of the potential of health hazards resulting from high intake of nitrates and nitrites, the assessment of these components in vegetables was undertaken in this study. The concentration of nitrates and nitrites in carrots and onions sampled from three central cities of Mazandaran state (Iran) was determined in 12 samples of each vegetable collected from farmlands of four geographical regions in each city using the ISO Method (NO. 6635). The average content of nitrates and nitrites in all of the samples was less than standard threshold limits. Babolsampled carrot had significantly higher nitrate content than two other cities. On the other hand, onions which were sampled from Sari showed significantly higher content of nitrate than two other cities. Based upon the maximum levels that were specified by European Commission Regulation, data showed that the investigated vegetables were safe for consumption.

show abstract

Section: Discussionsupporting

confidence: 94%

“…Nitrates and nitrites were shown to be associated with birth defects (Scragg 1982), cardiovascular defects (Morton 1971;Umah, Ketiku, and Sridhar 2003), and hypertrophy of the thyroid (van-Maanen et al 1994). The major adverse health effect in infants is methemoglobinemia (Menzer 1993;Finan et al 1998). …”

Section: Introductionmentioning

confidence: 99%

The measurement of nitrate and nitrite content in carrots and onions sampled from central cities of Mazandaran State of Iran

Shokrzadeh

Shokravie

Saravi

2008

Toxicological & Environmental Chemistry

View full text Add to dashboard Cite

show abstract

“…Acquired methemoglobinemia is the most common cause and has been related to different conditions, such as diarrhea (of infectious origin or secondary to cow milk protein intolerance) 8 -12 ; consumption of high-nitrate water (contaminated or well water that is mixed with infant formula) 4,5,13 ; or high-nitrate food (spinach, carrots, beets) [3][4][5]14,15 ; food-borne nitrates and nitrites (used as food preservative because they inhibit the growth of Clostridium botulinum) 16,17 ; exposure to certain drugs 1,4,18 including topical anesthetic agents (benzocaine, eutetic mixture of local anesthetics, prilocaine, lidocaine) and silver nitrate, chloroquine, sulfonamides, dapsone, phenacetin, sodium valproate, phenazopyridine, inhaled nitrous oxide, amyl nitrite, as well as acute nitrite toxicity resulting from accidental exposure to aniline dyes, coloring compounds or cleaning solutions. 19 In the cases reported here, the rare causes of hereditary methemoglobinemia (methemoglobin reductase deficiency, hemoglobinopathies) can be excluded because of the absence of an additional episode of cyanosis.…”

Section: Discussionmentioning

confidence: 99%

Methemoglobinemia and Consumption of Vegetables in Infants

Benito²,

2001

View full text Add to dashboard Cite

ABSTRACT. Objective. To assess clinical and epidemiologic data of 7 infants diagnosed with acquired methemoglobinemia at the pediatric emergency department between 1993 and 1998. All cases were attributed to the consumption of mixed vegetables.Methods. Medical records were reviewed to collect anamnestic data; history of food ingestion; and results of physical examination, pulse oximetry, gasometry, cooximetry, urinalysis, and outcome. Local health authorities provided information on nitrate concentration in running water and in vegetables of common consumption in the area.Results. The mean age of the patients was 8.14 months (range: 7-13). None of the infants was undernourished, had diarrhea, or was given any drug. Drinking water showed a nitrate concentration of 3 to 6 ppm. All were fed homemade purée of mixed vegetables, prepared in advance and kept in the refrigerator for 12 to 27 hours. Silver beets were a common ingredient. No case showed metabolic acidosis. Methemoglobin level ranged between 10% and 58%. Three cases had nitrituria. Silver beets in our area were the vegetables with the highest nitrate concentration (mean: 3200 mg/kg).Conclusions. Consumption of silver beets and incorrect storage of homemade purées of mixed vegetables were potential causes of methemoglobinemia in this series. The disease may occur in children older than 6 months of age. Nitrituria in a cyanotic infant may suggest the diagnosis of methemoglobinemia. Pediatrics 2001; 107:1024 -1028; methemoglobinemia, nitrates, nitrites, food analysis, infant food, food preservation.ABBREVIATIONS. Sao 2 , oxygen saturation; Hb, hemoglobin. M ethemoglobinemia is a rare cause of cyanosis in pediatric patients. Methemoglobin, a derivative of hemoglobin in which the iron component has been oxidized from the Fe 2ϩ to the Fe 3ϩ state, imparts a characteristic brownish color to blood and is unable to transport oxygen. 1,2 Under physiologic conditions, methemoglobin reduction is accomplished primarily by red cell reduced nicotinamide adenine dinucleotide reductase so efficiently that there is Ͻ1% of methemoglobin in the circulating blood. Hereditary methemoglobinemia is attributable either to deficiency of erythrocyte methemoglobin reductase or to the presence of one of the M hemoglobins. Acquired methemoglobinemia is induced by oxidizing agents, particularly chlorates and inorganic and organic nitrites, or by exposure to certain drugs or their metabolites.The most common sources of nitrate exposure are well water, which is mixed with infant formula, consumption of some vegetables with high nitrate concentration, administration of oxidant drugs, and the presence of diarrheal episodes. After ingestion, nitrates are converted to nitrites by fecal organisms, rapidly absorbed from the intestine by passive diffusion reaching the systemic circulation without undergoing first-pass metabolism in the liver (extrahepatic metabolism). Nitrites are potent oxidant agents of ferrohemoglobin. Infants younger than 6 months old are particularly susceptible to nitrate-...

show abstract

“…The normal MetHb level was set as 2% of total Hemoglobin (Hb) [2]. However, MetHb formation can be increased due to oxidant agents [1] such as drinking water nitrate [3], nitrate in some vegetables [1,[4][5][6], nitrite used as food preservative [4,7], some medications [5,8,9], or to some household chemicals [1,5,6].…”

Section: Introductionmentioning

confidence: 99%

Does Exposure to Nitrate in Drinking Water Contribute Anything the Effect of Water Chlorination on Children Methemoglobin Levels?

Sadeq¹,

Abouqal²,

Attarassi³

et al. 2012

JEP

View full text Add to dashboard Cite

Previous studies showed contradictory findings regarding the relationship between nitrate in drinking well-water and abnormal methemoglobin (MetHb) level (>2%) among children. We studied the effect of water chlorination in this relationship in children aged up to 7. 240 subclinical children participated in this cross-sectional study. Water nitrate was analyzed for each participant, and so was blood MetHb. Analysis of two water nitrate exposure levels (<50 and >50 mg/L as 3 )-other extraneous factors (Breslow-Day-Test for interaction), bivariate and multivariate analyses were performed. Abnormal MetHb levels (up to 7.9%) were associated (p-value = 0.020) with exposure to drinking water nitrate. Only water chlorination was an effect modifier. Among those who do not disinfect water, the prevalence of abnormal MetHb for those with nitrate level >50 mg/L was 4.95 (p-value = 0.001, 95% CI = [1.92 -12.79]) times the prevalence for those with nitrate level <50 mg/L. Whereas, among those who do disinfect water, the prevalence for those with high nitrate levels was only ) times the prevalence of those with low nitrate levels. The biological plausibility of a relationship between waterborne microorganisms, drinking water nitrate, drinking water chlorination, and development of an abnormal MetHb level needs to be further explored.

show abstract

Lesson of the week: Methaemoglobinaemia associated with sodium nitrite in three siblings

Cited by 21 publications

References 5 publications

The measurement of nitrate and nitrite content in carrots and onions sampled from central cities of Mazandaran State of Iran

The measurement of nitrate and nitrite content in carrots and onions sampled from central cities of Mazandaran State of Iran

Methemoglobinemia and Consumption of Vegetables in Infants

Does Exposure to Nitrate in Drinking Water Contribute Anything the Effect of Water Chlorination on Children Methemoglobin Levels?

Contact Info

Product

Resources

About