Methaemoglobinaemia in neonates with acute gastroenteritis: lethal, but curable

BMJ Case Rep. 2024 Dec 18;17(12):e262479. doi: 10.1136/bcr-2024-262479.

Abstract

Methaemoglobinaemia is a rare factor that can lead to cyanosis. The predominant cause of acquired methaemoglobinaemia is commonly attributed to anaesthetic agents. This case series presents three instances of acquired methaemoglobinaemia resulting from acute gastroenteritis caused by formula feeds. While uncommon, it is important to consider the potential occurrence of acquired methaemoglobinaemia because of acute gastroenteritis in newborns. This case series highlights the significance of promptly identifying and addressing the issue. The presence of metabolic acidosis and methaemoglobinaemia was detected and promptly treated by administering methylene blue and normal fluid therapy. Following that, the newborns have been discharged on exclusive breastfeeds. Despite being infrequent, the initial manifestation of these instances exhibited characteristics that deviated from the norm for a differential diagnosis in an infant experiencing hypoxia, metabolic acidosis and diarrhoea. It is crucial to promptly identify and administer methylene blue treatment to potentially rescue the life of the neonate.

Keywords: Neonatal and paediatric intensive care; Neonatal intensive care; Paediatrics (drugs and medicines).

Publication types

  • Case Reports

MeSH terms

  • Acidosis / etiology
  • Acute Disease
  • Diagnosis, Differential
  • Female
  • Gastroenteritis* / complications
  • Humans
  • Infant Formula
  • Infant, Newborn
  • Male
  • Methemoglobinemia* / chemically induced
  • Methemoglobinemia* / diagnosis
  • Methemoglobinemia* / drug therapy
  • Methylene Blue* / administration & dosage
  • Methylene Blue* / therapeutic use

Substances

  • Methylene Blue