PT  - JOURNAL ARTICLE
AU  - Simi Kurian
AU  - Nalinikanta Panigrahy
AU  - Vijayanand Jamalpuri
AU  - Dinesh Chirla
TI  - Cow’s milk protein allergy in a neonate presenting with methaemoglobinaemia
AID  - 10.1136/bcr-2021-246599
DP  - 2022 Aug 01
TA  - BMJ Case Reports
PG  - e246599
VI  - 15
IP  - 8
4099  - http://casereports.bmj.com/content/15/8/e246599.short
4100  - http://casereports.bmj.com/content/15/8/e246599.full
SO  - BMJ Case Reports2022 Aug 01; 15
AB  - Cow’s milk protein allergy (CMPA) is the most common food allergy in infants. A previously healthy neonate fed with infant formula presented diarrhoea, vomiting and respiratory distress with cyanosis. Investigations showed thrombocytosis and leucocytosis with lymphocyte predominance. To our surprise blood gas analysis showed metabolic acidosis and a high methaemoglobin level of 33% (normal range <3%). Clinical status, metabolic acidosis and methaemoglobin level returned to normal following fluid resuscitation and methylene blue administration. The neonate was later managed with breast feeding and elemental formula. CMPA was diagnosed based on history and clinical improvement after elemental formula. Although not common in CMPA, methaemoglobinaemia should be recognised as a differential diagnosis in a hypoxic infant with metabolic acidosis and diarrhoea as early recognition and treatment with methylene blue can save a child’s life.