DOI QR코드

DOI QR Code

Methemoglobinemia development after ingestion of a chinese herbal medicine: A case report

한약 복용 후 발생한 메트헤모글로빈혈증 1예

  • Hyun, Se Eun (Department of Pediatrics, Pochon Medical College, Bundang CHA Hopital) ;
  • Hwang, Pil Joo (Department of Pediatrics, Pochon Medical College, Bundang CHA Hopital) ;
  • Nam, Kyung Pil (Department of Civil and Environment Engineering, Seoul National University) ;
  • Yoo, Eun Gyong (Department of Pediatrics, Pochon Medical College, Bundang CHA Hopital) ;
  • Han, Man Yong (Department of Pediatrics, Pochon Medical College, Bundang CHA Hopital)
  • 현세은 (포천중문의과대학교 소아과학교실) ;
  • 황필주 (포천중문의과대학교 소아과학교실) ;
  • 남경필 (서울대학교 건설환경공학부) ;
  • 유은경 (포천중문의과대학교 소아과학교실) ;
  • 한만용 (포천중문의과대학교 소아과학교실)
  • Received : 2008.08.18
  • Accepted : 2008.10.26
  • Published : 2009.03.15

Abstract

An 8-year-old girl visited the emergency room with perioral cyanosis and dyspnea, which had developed 20 hrs prior to the hospital visit. She had taken a Chinese herbal medication for 3 days prior to the onset of the symptoms. A co-oximeter examination revealed a methemoglobin level of 23.7%. An intravenous infusion of methylene blue was administered. Chemical analysis of the herbal medication revealed an ammonia (NH$_{3}$) level of 239.41 mg/L. More studies are needed on the correlation between methemoglobinemia and the components of Chinese herbal medicines.

8세 여아가 증상 발현 3일전부터 한약을 복용 후, 내원 20시간 전에 발생한 청색증과 호흡곤란을 주소로 응급실에 내원하였다. 내원 당시 메트헤모글로빈 수치가 23.7%로, 메트헤모글로빈혈증 진단 하에 methylene blue로 치료하였다. 한약 성분은 암모니아가 239.41 mg/L로 높게 측정되었다. 이에 한약 복용 후 발생한 메트헤모글로빈혈증 1예를 보고하고자 한다.

Keywords

References

  1. Wilburn-Goo D, Lloyd LM. When patients become cyanotic: Acquired methemoglobinemia. J Am Dent Assoc 1999;130: 826-31
  2. Rehman HU. Methemoglobinemia. West J Med 2001;175: 193-6 https://doi.org/10.1136/ewjm.175.3.193
  3. Hamirani YS, Franklin W, Grifka RG, Stainback RF. Methemoglobinemia in a young man. Tex Heart Inst J 2008;35: 76-7
  4. Lee SW, Lee JY, Lee KJ, Kim M, Kim MJ. A case of methemoglobinemia after ingestion of an aphrodisiac, later proven as dapsone. Yonsei Med J 1999;40:388-91
  5. Seong NH, Kim YW, Heo WJ, Lim CH, Kim JS, Paek SK, et al. A case of acute hemolytic anemia and methemoglobinemia induced by massive dapsone intoxication. Korean J Hematol 1997;32:106-11
  6. Craun GF, Greathouse DG, Gunderson DH. Methaemoglobin levels in young children consuming high nitrate well water in the United States. Int J Epidemiol 1981;10:309-17 https://doi.org/10.1093/ije/10.4.309
  7. Askew GL, Finelli L, Genese CA, Sorhage FE, Sosin DM, Spitalny KC. Boilerbaisse: An outbreak of methemoglobinemia in New Jersey in 1992. Pediatrics 1994;94:381-4
  8. Knobeloch L, Salna B, Hogan A, Postle J, Anderson H. Blue babies and nitrate-contaminated well water. Environ Health Perspect 2000;108:675-8
  9. Lee BH, Suh JY, Kim NS, Lee H, Kim YY, Choi BY, et al. Analysis of contaminated ground water inducing methemoglobinemia and epidemiologic investigation of contaminated ground water. J Korean Pediatr Soc 1995;38:507-12
  10. Kim YY, Choi BY, Park HB, Kim MY, Yeo IH. Epidemiologic investigation to identify the cause of an infant methemoglobinemia. Korean J Prev Med 1993;26:192-201
  11. Jung JA, Lee JW, Seo JW. Methemoglobinemia associated with diarrheal disease before 2 months of age. J Korean Pediatr Soc 2001;44:1387-94
  12. Kim HG, Kim CS, Lee SL. Clincal features of methemoglobinemia in newborn diarrhea infant. J Korean Soc Neonatol 1997;4:238-45
  13. Kim HM. Transient methemoglobinemia with acidosis in newborn. J Korean Pediatr Soc 1994;37:416-21
  14. Kim YS, Kim EA, Lim JY, Choi MB, Park CH, Woo HO, et al. Changes in incidence of infantile transient methemoglobinemia associated with infectious diarrhea during 1989-1999 in Kyungnam province. J Korean Pediatr Soc 2000;43:1569- 75
  15. Hjelt K, Lund JT, Scherling B, Bendixen S, Lundstrom K, Stovring S, et al. Methaemoglobinaemia among neonates in a neonatal intensive care unit. Acta Paediatr 1995;84:365-70 https://doi.org/10.1111/j.1651-2227.1995.tb13650.x
  16. Chui JS, Poon WT, Chan KC, Chan AY, Buckley TA. Nitrite-induced methaemoglobinaemia - aetiology, diagnosis and treatment. Anaesthesia 2005;60:496-500 https://doi.org/10.1111/j.1365-2044.2004.04076.x
  17. Chan B, Ui LQ, Ming TP, Lai CK, Chan BY, Poon WT, et al. Methemoglobinemia after ingestion of Chinese herbal medicine in a 9-day-old infant. Clin Toxicol (Phila) 2007;45: 281-3
  18. Cabello P, Roldan MD, Moreno-Vivian C. Nitrate reduction and the nitrogen cycle in archaea. Microbiology 2004;150: 3527-46 https://doi.org/10.1099/mic.0.27303-0
  19. Morozkina EV, Zvyagilskaya RA. Nitrate reductases: Structure, functions, and effect of stress factors. Biochemistry (Mosc) 2007;72:1151-60 https://doi.org/10.1134/S0006297907100124
  20. Zhang L, Zheng P, Tang CJ, Jin RC. Anaerobic ammonium oxidation for treatment of ammonium-rich wastewaters. J Zhejiang Univ Sci B 2008;9:416-26
  21. Bradberry SM, Aw TC, Williams NR, Vale JA. Occupational methaemoglobinaemia. Occup Environ Med 2001;58:611 https://doi.org/10.1136/oem.58.9.611