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. 1999 Jul;107(7):583–586. doi: 10.1289/ehp.99107583

Infantile methemoglobinemia: reexamining the role of drinking water nitrates.

A A Avery 1
PMCID: PMC1566680  PMID: 10379005

Abstract

Ingestion of nitrates in drinking water has long been thought to be a primary cause of acquired infantile methemoglobinemia, often called blue baby syndrome. However, recent research and a review of historical cases offer a more complex picture of the causes of infantile methemoglobinemia. Gastrointestinal infection and inflammation and the ensuing overproduction of nitric oxide may be the cause of many cases of infantile methemoglobinemia previously attributed to drinking water nitrates. If so, current limits on allowable levels of nitrates in drinking water, which are based solely on the health threat of infantile methemoglobinemia, may be unnecessarily strict.

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Selected References

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  1. Avner J. R., Henretig F. M., McAneney C. M. Acquired methemoglobinemia. The relationship of cause to course of illness. Am J Dis Child. 1990 Nov;144(11):1229–1230. doi: 10.1001/archpedi.1990.02150350061025. [DOI] [PubMed] [Google Scholar]
  2. Centers for Disease Control and Prevention (CDC) Methemoglobinemia in an infant--Wisconsin, 1992. MMWR Morb Mortal Wkly Rep. 1993 Apr 2;42(12):217–219. [PubMed] [Google Scholar]
  3. Dagan R., Zaltzstein E., Gorodischer R. Methaemoglobinaemia in young infants with diarrhoea. Eur J Pediatr. 1988 Jan;147(1):87–89. doi: 10.1007/BF00442620. [DOI] [PubMed] [Google Scholar]
  4. Dötsch J., Demirakca S., Hamm R., Knothe C., Bauer J., Kühl P. G., Rascher W. Extracorporeal circulation increases nitric oxide-induced methemoglobinemia in vivo and in vitro. Crit Care Med. 1997 Jul;25(7):1153–1158. doi: 10.1097/00003246-199707000-00016. [DOI] [PubMed] [Google Scholar]
  5. Faivre J., Faivre M., Klepping C., Roche L. Les méthémoglobinémies induites par l'ingestion de nitrites et de nitrates. Ann Nutr Aliment. 1976;30(5-6):831–838. [PubMed] [Google Scholar]
  6. Gebara B. M., Goetting M. G. Life-threatening methemoglobinemia in infants with diarrhea and acidosis. Clin Pediatr (Phila) 1994 Jun;33(6):370–373. doi: 10.1177/000992289403300611. [DOI] [PubMed] [Google Scholar]
  7. Gupta S. K., Fitzgerald J. F., Chong S. K., Croffie J. M., Garcia J. G. Expression of inducible nitric oxide synthase (iNOS) mRNA in inflamed esophageal and colonic mucosa in a pediatric population. Am J Gastroenterol. 1998 May;93(5):795–798. doi: 10.1111/j.1572-0241.1998.227_a.x. [DOI] [PubMed] [Google Scholar]
  8. Hack W. W., Douwes A. C., Veerman A. J. Spinazie: bron van nitrietvergiftiging bij jonge kinderen. Ned Tijdschr Geneeskd. 1983 Aug 6;127(32):1428–1431. [PubMed] [Google Scholar]
  9. Hanukoglu A., Danon P. N. Endogenous methemoglobinemia associated with diarrheal disease in infancy. J Pediatr Gastroenterol Nutr. 1996 Jul;23(1):1–7. doi: 10.1097/00005176-199607000-00001. [DOI] [PubMed] [Google Scholar]
  10. Hegesh E., Shiloah J. Blood nitrates and infantile methemoglobinemia. Clin Chim Acta. 1982 Oct 27;125(2):107–115. doi: 10.1016/0009-8981(82)90187-5. [DOI] [PubMed] [Google Scholar]
  11. Johnson C. J., Bonrud P. A., Dosch T. L., Kilness A. W., Senger K. A., Busch D. C., Meyer M. R. Fatal outcome of methemoglobinemia in an infant. JAMA. 1987 May 22;257(20):2796–2797. [PubMed] [Google Scholar]
  12. Jolly B. T., Monico E. P., McDevitt B. Methemoglobinemia in an infant: case report and review of the literature. Pediatr Emerg Care. 1995 Oct;11(5):294–297. [PubMed] [Google Scholar]
  13. Kay M. A., O'Brien W., Kessler B., McVie R., Ursin S., Dietrich K., McCabe E. R. Transient organic aciduria and methemoglobinemia with acute gastroenteritis. Pediatrics. 1990 Apr;85(4):589–592. [PubMed] [Google Scholar]
  14. Keating J. P., Lell M. E., Strauss A. W., Zarkowsky H., Smith G. E. Infantile methemoglobinemia caused by carrot juice. N Engl J Med. 1973 Apr 19;288(16):824–826. doi: 10.1056/NEJM197304192881606. [DOI] [PubMed] [Google Scholar]
  15. Lebby T., Roco J. J., Arcinue E. L. Infantile methemoglobinemia associated with acute diarrheal illness. Am J Emerg Med. 1993 Sep;11(5):471–472. doi: 10.1016/0735-6757(93)90086-q. [DOI] [PubMed] [Google Scholar]
  16. Levine J. J., Pettei M. J., Valderrama E., Gold D. M., Kessler B. H., Trachtman H. Nitric oxide and inflammatory bowel disease: evidence for local intestinal production in children with active colonic disease. J Pediatr Gastroenterol Nutr. 1998 Jan;26(1):34–38. doi: 10.1097/00005176-199801000-00006. [DOI] [PubMed] [Google Scholar]
  17. Luk G., Riggs D., Luque M. Severe methemoglobinemia in a 3-week-old infant with a urinary tract infection. Crit Care Med. 1991 Oct;19(10):1325–1327. doi: 10.1097/00003246-199110000-00017. [DOI] [PubMed] [Google Scholar]
  18. Lukens J. N. Landmark perspective: The legacy of well-water methemoglobinemia. JAMA. 1987 May 22;257(20):2793–2795. [PubMed] [Google Scholar]
  19. May R. B. An infant with sepsis and methemoglobinemia. J Emerg Med. 1985;3(4):261–264. doi: 10.1016/0736-4679(85)90428-7. [DOI] [PubMed] [Google Scholar]
  20. Murray K. F., Christie D. L. Dietary protein intolerance in infants with transient methemoglobinemia and diarrhea. J Pediatr. 1993 Jan;122(1):90–92. doi: 10.1016/s0022-3476(05)83495-x. [DOI] [PubMed] [Google Scholar]
  21. Roediger W. E., Radcliffe B. C. Role of nitrite and nitrate as a redox couple in the rat colon. Implications for diarrheal conditions. Gastroenterology. 1988 Apr;94(4):915–922. doi: 10.1016/0016-5085(88)90547-1. [DOI] [PubMed] [Google Scholar]
  22. SIMON C., MANZKE H., KAY H., MROWETZ G. UBER VORKOMMEN, PATHOGENESE UND MOEGLICHKEITEN ZUR PROPHYLAXE DER DURCH NITRIT VERURSACHTEN METHAEMOGLOBINAEMIE. Z Kinderheilkd. 1964 Nov 5;91:124–138. [PubMed] [Google Scholar]
  23. Sander C., Jacobi H. Methämoglobinvergiftung nach Spinatgenuss bei einem zweijährigen Knaben. Z Kinderheilkd. 1967;98(3):222–226. [PubMed] [Google Scholar]
  24. Smith M. A., Shah N. R., Lobel J. S., Hamilton W. Methemoglobinemia and hemolytic anemia associated with Campylobacter jejuni enteritis. Am J Pediatr Hematol Oncol. 1988 Spring;10(1):35–38. doi: 10.1097/00043426-198821000-00007. [DOI] [PubMed] [Google Scholar]
  25. WALTON G. Survey of literature relating to infant methemoglobinemia due to nitrate-contaminated water. Am J Public Health Nations Health. 1951 Aug;41(8 Pt 1):986–996. doi: 10.2105/ajph.41.8_pt_1.986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Yano S. S., Danish E. H., Hsia Y. E. Transient methemoglobinemia with acidosis in infants. J Pediatr. 1982 Mar;100(3):415–418. doi: 10.1016/s0022-3476(82)80446-0. [DOI] [PubMed] [Google Scholar]

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