The Blood Blues: Homemade Infant Food Might Be Dangerous!

Objectives: Home-prepared food is believed to be healthier and with less chemical food additives than industrially made products. However, state control insures infant food to be without noxious content which is not guaranteed for home-made nutrition.

Methods: A 4-month-old previously healthy boy was admitted to a pediatric hospital with sudden clinical deterioration. Physical examination revealed an evidently sick boy with respiratory failure, central cyanosis, and weak femoral pulses. The transcutaneous pulse oximetry measured an oxygen saturation of 86% and the venous blood gas analysis showed a lactic acidosis with a pH of 6.9. Via echocardiography, a critical coarctation of the aorta with consecutively impaired blood supply of the lower body was suspected. With continuous drip infusion of alprostadil and mechanical ventilation, the boy was transferred to our unit. In regard to the severe clinical condition of the patient, he was admitted directly to our heart catheterization laboratory. Our echocardiography showed normal, unimpaired, cardiac function without a ductus arteriosus. Echocardiographically, a critical coarctation of the aorta could not be ruled out completely. Our angiography showed no congenital heart defect and especially no aortic coarctation. However, the arterial blood was “chocolate brown” which prompted a new arterial blood gas analysis including methemoglobin. This revealed an oxygen saturation of 52% and a methemoglobin level of 50% (normal: 0–1.5%). Immediate application of intravenous toluidine blue solution cured the boy. Later, the mother reported that the boy had had a home-made vegetable purée for lunch which contained beetroot and has been frozen several times at that day. The chemical analysis of the purée revealed a high concentration of nitrite (591 mg/kg). Fortunately, no neurologic sequelae remained.

Conclusion: Secondary clinical deterioration of infants may occur due to many reasons including cardiac defects and metabolic disorders. The difference between the saturation measured by transcutaneous pulse oximetry and the blood gas analysis, as well as the chocolate color of the blood, are typical for methemoglobinemia. Our case shows that the consumption of a home-made beetroot preparation and the incorrect storage in infants may lead to a life-threatening methemoglobinemia which can be misdiagnosed as a congenital heart defect.

Publication History

Article published online:
21 February 2021