Prevention of methemoglobinemia in children19.11.2018
Methemoglobinemia * – the ability of hemoglobin to bind and transport oxygen is associated with the iron of the heme group.
Cases of methemoglobinemia caused by well water containing nitrate are common. For bottle-fed infants in villages, well water is used mainly to dilute milk or formula milk. The most common reason for the high concentration of nitrates in drinking water may be due to wells dug in the vicinity of manure heaps, sheds, latrines, the use of manure or fertilizers in agriculture. The natural level of nitrites and nitrates from the environment is usually a few milligrams per liter, although naturally high levels can occur in some areas. Under the influence of intensive agriculture, this level may exceed 50 mg / liter (WHO, 1998). It has been established that levels in excess of 50 mg / liter are associated with methemoglobinemia in infants fed from a bottle. Nitrates are also found in vegetables. Methemoglobinemia can also be a side effect of the action of some drugs (fenacitin and sulfonamides), but with the use of modern drugs this happens very rarely.
The clinical picture is very characteristic. Artificially fed, often dyspeptic infants (usually living in villages) suddenly appear pronounced cyanosis (a change in the color of the nasolabial triangle and the fingers, toes). Other clinical symptoms (lethargy, decreased motor activity, increased breathing, a drop in blood pressure, in severe cases – loss of consciousness and convulsions) are not so pronounced. And this difference in itself suggests the possibility of methemoglobinemia. With a more thorough examination of the child, a grayish rather than a bluish tint of the skin is noted. It is diagnostically important that there is no disease that could cause cyanosis (congenital heart disease, pneumonia). The rapid success of treatment, the spectroscopic detection of methemoglobin, as well as the establishment of a high concentration of nitrate in the well water used for the cultivation of milk, also help to accurately diagnose.
In order to avoid methemoglobinemia and its recurrence, it is necessary instead of the water used previously to achieve the use of such water from an artesian or other well, which, according to chemical analysis, is suitable for this. Children under the age of 3 years completely exclude the use of water from wells.
District pediatrician T.N. Chigir