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What Is The Differences Between Congenital And Acquired Methemoglobinemia?

Posted on Mon, 7 Sep 2015

Question: my kid is 28months old and she is suffering from Methemoglobinemia.it was 40% when we detected it first time an later dropped down to 18% without giving any treatment and later methylene blue was given to bring her levels down , now its at 12% and she is taking vitamin C and Riboflavin.
her Oxygen saturation was 98% initially , she as no issues except the blueness when we monitored. now OS levels are at 90%. From the beginning we had no issues with her health except cold which is common up to Age of 5.Her Physical development is normal. very active baby. we checked with few hematologists in HYD and some say it is conginental and some Acquired.
Please let us know how can we clarify it?

Answered by Dr. Hardik Sanghvi (2 hours later)

Brief Answer:
She mostly have acquired methemoglobinemia.

Detailed Answer:
Hi, dear
I have gone through your question. I have gone through her all reports. I can understand your concern.
She has very high level of methemoglobin. It should be less then 1% normally.
So her rbc can not release the oxygen and causing cynosis. She was given methylene blue and oxygen which is the treatment of choice. Methylene blue restore the it is normal form and relieve the symptoms.

Chances of congenital methemoglobinemia is very rare. Congenital methemoglobinemia is very rare condition in which the enzyme NADH methemoglobin reductase is deficient and it is genetic disease present with neonatal cynosis. Your daughter present at age of 3 year.

She mostely have acquired methemoglobinemia. Many drugs like antibiotics (sulfonamides (~Bactrim) and dapsone), local anesthetics, aniline dyes, metoclopramide can cause that. Ingestion of compounds containing nitrates (can also cause methemoglobinemia.

Her other system are totally normal, her electrophoresis report is also normal. So no need to worry. Just continue your treatment as per advice and give follow up with methemoglobin level.

Hope I have answered your question. If you have any doubts then feel free to ask me. I will be happy to answer.
Thanks for using health care magic. Wish you a very good health.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hardik Sanghvi (23 minutes later)

Hello Doctor,

Thanks for your reply.

We came to know there is a genetic test to confirm whether it is conginental or acquired done in Cochi.

Could you let us know if you are aware of any tests done her in XXXXXXX
can we know which drugs caused her Methemoglobinemia, so that we can avoid it in future?
attached her g6pd report

Answered by Dr. Hardik Sanghvi (20 hours later)

Brief Answer:
Genetic tests are available to check the presence or absence of enzyme.

Detailed Answer:
Hi, dear
I have gone through your question.
Genetic testing is available to confirm congenital methemoglobinemia. It will detect the enzymes. You can check whether it is done in Cochin or not. It it available in few labs in XXXXXXX and Bombay. I don't know exactly the place. But in my opinion it is not needed.

There are many drugs which are known to cause methemoglobinemia.
Benzocaine, Celecoxib, Chloroquine, Cotrimoxazole, Cyclophosphamide, Dapsone, Disulfiram, Flutamide, Ibuprofen, Ifosfamide, Metoclopramide, Nitrites and nitrates, Phenazopyridine, Prilocaine, Primaquine, Sulfonamides, Tetracaine, Vitamin K, Zopiclone are the important drugs causing methemoglobinemia. Try to avoid these drugs in future or give it under observation.

Your daughter has no G6PD deficiency. G6PD is X linked disease so females are only carrier and generally they don't manifest the disease. so no need to worry about that.

Hope I have answered your question. If you have any doubts then feel free to ask me. I will be happy to answer. Thanks for using health care magic. Wish you a very good health.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hardik Sanghvi (41 hours later)

Hello Doc,

here is the list of medicines we have her.I could not find any information about drugs so :

Ceftriaxone IV (when admitted for neumonia)
Amikacin 50mg
Taximo 50mg
Tminic
Zincovit
Montair Lc Kid
Delcon
Ambodil S
Maxtra Syrup
Oflox 50mg
Clampkid Forte
Xyzal Syrup
Bifilac
BestVita multivitamin drops

and using cetaphil lotion +Teddy bar Soap
3
caused by any preservatives added in food?

let us know if any of these might have caused the problem
her saturation levels are at 90% now, what precautions can we take in her case as it will have impact on her heart,or the other organs.
IS beta carotene the reason?

Answered by Dr. Hardik Sanghvi (9 hours later)

Brief Answer:
It may be due to some diarrhea, sepsis, food or water contamination.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
She has given mainly antibiotics, cough syrup, multivitamins drugs for diarrhea.
Most of all the drugs are safe and they don't cause methemoglobinemia.

She may have dehydration usually caused by gastroenteritis with diarrhea or sepsis, or some food with nitrate or drinking water with high nitrate level. These all can leads to methemoglobinemia.

Her oxygen saturation level is acceptable. Nothing much worried about that. She should avoid all the drugs listed previously. check nitrate content of drinking water and avoid high nitrate containing food or water. Avoid dehydration and if she has diarrhea then consult your doctor and treat it urgently.

Beta carotene has nothing to do with methemoglobinemia. Don't worry about that.

Hope I have answered your question. If you have any doubts then feel free to ask me again. I will be happy to answer.
Thanks for using health care magic.
Wish you a very good health.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar