Pollack E S, Pollack C V
Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona.
Ann Emerg Med. 1994 Oct;24(4):652-6. doi: 10.1016/s0196-0644(94)70275-6.
Infants with diarrhea are at a greater-than-recognized risk of developing methemoglobinemia.
Prospective clinical study.
A university hospital pediatric emergency department.
Consecutive infants under 6 months of age with a history of diarrhea of more than 24 hours' duration not associated with vomiting.
Blood samples were obtained for methemoglobin (MHgb) assay (normal, 0.4% to 1.5%) and electrolytes. Treatment interventions were performed as clinically indicated. Patients with elevated MHgb levels subsequently underwent hemoglobin electrophoresis to exclude congenital methemoglobinemia.
Forty-three patients were studied; 27 (64%) had elevated MHgb levels and 13 were cyanotic. Five patients received infusions of methylene blue for methemoglobinemia. All patients recovered without sequelae. There was a strong correlation between weight at or below the tenth percentile for age and the development of methemoglobinemia. Contrary to previous studies, there was no correlation between incidence or severity of methemoglobinemia and acidosis, hyperchloremia, or positive microbiologic studies.
In ill infants with diarrhea, particularly those who are small for age, consideration should be given to screening for methemoglobinemia.
腹泻婴儿发生高铁血红蛋白血症的风险高于已知水平。
前瞻性临床研究。
一家大学医院的儿科急诊科。
连续纳入的6个月以下有超过24小时腹泻病史且无呕吐的婴儿。
采集血样检测高铁血红蛋白（MHgb）水平（正常范围为0.4%至1.5%）及电解质。根据临床指征进行治疗干预。高铁血红蛋白水平升高的患者随后接受血红蛋白电泳以排除先天性高铁血红蛋白血症。
共研究了43例患者；27例（64%）高铁血红蛋白水平升高，13例出现发绀。5例患者因高铁血红蛋白血症接受了亚甲蓝输注。所有患者均康复且无后遗症。年龄体重处于或低于第十百分位数与高铁血红蛋白血症的发生密切相关。与既往研究相反，高铁血红蛋白血症的发生率或严重程度与酸中毒、高氯血症或微生物学检查阳性无关。
对于患有腹泻的患病婴儿，尤其是那些年龄偏小的婴儿，应考虑筛查高铁血红蛋白血症。
