Recently, the City Children's Hospital (HCMC) received a case of a 16-month-old girl named PTM, residing in Can Duoc, Long An , in critical condition with symptoms of cyanosis all over her body, and blood oxygen index (SpO2) reduced to 75%.
The cause was determined to be methemoglobin poisoning after the child ate a lunch of crab and spinach soup cooked with well water.
According to the family, about an hour after the meal, while playing, the baby suddenly started, his lips turned purple and his skin turned pale, with no previous signs of coughing or food allergies.
At the time of admission, doctors noted that the baby was fussy, had no fever, no skin rash, no wheezing or vomiting, but was severely cyanotic.
Blood gas analysis showed severe hypoxia, metabolic acidosis with elevated blood lactate (4.8 mmol/L). Liver, renal, and electrolyte function tests were normal.
To diagnose, doctors perform an air exposure blood sample test by taking the baby's blood into a syringe, capping it, and shaking it 50 times.
The results showed that the blood remained dark brown, not turning red like normal blood. This is a typical sign of methemoglobinemia, a condition in which red blood cells cannot bind oxygen because hemoglobin is oxidized from Fe2+ to Fe3+.
The baby's blood sample turned dark brown (Photo: Hospital).
Immediately, the child was given oxygen support, intravenous injection of methylene blue antidote (dose 1 mg/kg) and activated charcoal to remove toxins through the digestive tract.
After only 5-10 minutes, the baby's skin gradually turned rosy. After 30 minutes, SpO₂ increased to 95%, the condition improved significantly. The patient was further monitored and recovered well, leaving no sequelae.
Doctor Nguyen Minh Tien, Deputy Director of the City Children's Hospital, said that the cause of methemoglobin poisoning may be related to nitrate (NO3⁻) in well water.
Nitrate when entering the body is converted into nitrite and oxidizes hemoglobin into methemoglobin, causing red blood cells to lose their ability to transport oxygen.
This causes tissue hypoxia, cyanosis, increased blood lactate, and metabolic acidosis, which is especially dangerous in young children, especially newborns or premature infants.
In addition to well water, some foods such as spinach, beets, and amaranth contain high levels of nitrate. If combined with untreated well water, the risk of poisoning increases.
Doctor Tien recommends that parents should use standard tap water for cooking, avoid using well water that has not been tested for quality.
In particular, using boiled red vegetables (like beets) to mix milk for children, with the concept of "blood tonic", can have serious consequences.
“Parents should use safe tap water when cooking. Some vegetables such as amaranth, beetroot, etc. have high nitrate content. Using water cooked from these vegetables to mix with breast milk can cause methemoglobinemia, especially in premature babies,” Dr. Tien emphasized.
Source: https://dantri.com.vn/suc-khoe/mau-be-gai-chuyen-mau-nau-sau-bua-trua-canh-bao-thoi-quen-nau-an-nguy-hiem-20250623192839201.htm
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