Connect
MJA
MJA

Methaemoglobinaemia following ingestion of a commonly available food additive

Peter Maric, Sayed S Ali, Leon G Heron, David Rosenfeld and Matthew Greenwood
Med J Aust 2008; 188 (3): . || doi: 10.5694/j.1326-5377.2008.tb01559.x
Published online: 4 February 2008

Five cases of methaemoglobinaemia after ingestion of sodium nitrite occurred in two clusters in Sydney in 2006. All cases were unintentional poisonings following use in cooking of an imported compound sold as a food additive. In all cases, methaemoglobinaemia was recognised early and treated promptly, with all patients making a full recovery. These cases highlight the importance of accurate food labelling and surveillance of imported goods.

In 2006, at Liverpool Hospital in Sydney, two separate clusters of patients presented to the emergency department with cyanosis after consuming home-prepared food to which sodium nitrite had been added.


  • 1 Department of Haematology, Liverpool Hospital, Sydney, NSW.
  • 2 Sydney South West Area Health Service, Sydney, NSW.


Correspondence: p_maric@hotmail.com

Acknowledgements: 

We thank Alan Giles, Emergency Consultant at Liverpool Hospital, for his generous assistance and input. We also thank Craig Shadbolt, Manager of the Foodborne Illness Investigation Unit, NSW Food Authority, for his input on the details of the investigation.

Competing interests:

None identified.

  • 1. Darling R, Roughton F. The effect of methemoglobin on the equilibrium between oxygen and hemoglobin. Am J Physiol 1942; 137: 56-68.
  • 2. Prchal JT, Gregg XT. Red cell enzymes. Hematology Am Soc Hematol Educ Program 2005; 19-23.
  • 3. Percy MJ, McFerran NV, Lappin TR. Disorders of oxidised haemoglobin. Blood Rev 2005; 19: 61-68.
  • 4. Maimo G, Redick E. Recognizing and treating methemoglobinemia: a rare but dangerous complication of topical anesthetic or nitrate overdose. Dimens Crit Care Nurs 2004; 23: 116-118.
  • 5. Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: etiology, pharmacology, and clinical management. Ann Emerg Med 1999; 34: 646-656.
  • 6. Brunato F, Garziera MG, Briguglio E. A severe methaemoglobinemia induced by nitrates: a case report. Eur J Emerg Med 2003; 10: 326-330.
  • 7. Khan NA, Kruse JA. Methemoglobinemia induced by topical anesthesia: a case report and review. Am J Med Sci 1999; 318: 415-418.
  • 8. Jalloh A, Tantular IS, Pusarawati S, et al. Rapid epidemiologic assessment of glucose-6-phosphate dehydrogenase deficiency in malaria-endemic areas in Southeast Asia using a novel diagnostic kit. Trop Med Int Health 2004; 9: 615-623.
  • 9. Bradberry SM, Aw TC, Williams NR, Vale JA. Occupational methaemoglobinaemia. Occup Environ Med 2001; 58: 611-615.
  • 10. Linden CH, Hall AH, Kulig KW, Rumack BH. Acute ingestions of boric acid. J Toxicol Clin Toxicol 1986; 24: 269-279.
  • 11. Teshima D, Taniyama T, Oishi R. Usefulness of forced diuresis for acute boric acid poisoning in an adult. J Clin Pharm Ther 2001; 26: 387-390.
  • 12. Titov VY, Petrenko YM. Proposed mechanism of nitrite-induced methemoglobinemia. Biochemistry (Mosc) 2005; 70: 473-483.
  • 13. Askew GL, Finelli L, Genese CA, et al. Boilerbaisse: an outbreak of methemoglobinemia in New Jersey in 1992. Pediatrics 1994; 94: 381-384.
  • 14. Chan TY. Food-borne nitrates and nitrites as a cause of methemoglobinemia. Southeast Asian J Trop Med Public Health 1996; 27: 189-192.
  • 15. Kennedy N, Smith CP, McWhinney P. Faulty sausage production causing methaemoglobinaemia. Arch Dis Child 1997; 76: 367-368.
  • 16. Food Standards Australia New Zealand. Food standards code and user guides. http://www.foodstandards.gov.au/thecode (accessed Oct 2007).

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.