Methemoglobinemia is an alteration of the oxidative state of hemoglobin. When methemoglobin values rise above 10%, the symptoms and signs related to this condition appear, such as cyanosis, respiratory problems, fatigue and headache. Acquired methemoglobinemia is characterized by the sudden onset of cyanosis in a previous healthy child, which can be due to exposure to medications or chemical substances including nitrates, copper, sulfates, chlorites, chloramines and chlorates which can be present in food and water. We illustrate two cases of acquired methemoglobinemia related to nitrate ingestion from a vegetable source. Introduction Methemoglobinemia is a rare blood cells disorder due to the hemoglobin iron oxidation from a ferrous to a ferric state. Methemoglobin (MET) cannot carry and release oxygen, with cyanosis and tissue hypoxemia as the consequence. Normal MET concentration in the blood is less than 2%.1 Methemoglobinemia can be congenital or acquired. Congenital methemoglobinemia is characterized by early onset of cyanosis without any cardiac and pulmonary disease. Acquired methemoglobinemia is characterized by sudden cyanosis onset in a previous healthy child and can be due to exposure to medications, food and water. Acute diarrhea may also cause oxidation of hemoglobin to methemoglobin (Table 1).2 Although Acquired methemoglobinemia has been well described before, this represents a challenging condition for any clinicians. Indeed, in order to avoid long-term consequences and reduce the risk of repeated episodes, it is very important to identify this disease and carry out an accurate history to identify its etiology.3 We present two cases of acquired methemoglobinemia related to nitrate ingestion from a vegetable source, in order to remind practitioners that the acute onset of cyanosis can depend on other factors than cardiovascular and/or respiratory disease.

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An acquired acute methemoglobinemia from dietary sources: Case reports and literature review

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An acquired acute methemoglobinemia from dietary sources: Case reports and literature review