Cyanosis accompanied by mottling in a lethargic neonate with tachycardia indicates shock.
Other differential diagnoses for cyanosis are: sepsis, hypovolemia, intra-abdominal surgical emergency, and metabolic crisis from inborn errors of metabolism (IEM).
Methemoglobinemia: Methemoglobinemia is characterized by cyanosis without underlying cardiac or pulmonary disease. The infant can look cyanotic to gray, with an almost normal-appearing pulse oximetry. Supplemental oxygen will not alter the color. Methemoglobinemia is confirmed by venous or capillary blood gas or the persistence of a chocolate-brown color of a blood drop on filter paper.
Initial treatment for methemoglobinemia is first searching and removing the offending agent, which is most often topical anesthetic agents, aniline dyes, and high levels of nitrate in the water supplies. Levels of methemoglobinemia above 20% are associated with clinical symptoms. If methemoglobinemia is greater than 30% of total hemoglobin, consider a dose of methylene blue, 1 to 2 mg/kg, given over 5 minutes.
Author(s) Details:
Elsharif Ahmed Bazie,
Elimam Elmahdi University, Sudan.
Mona Isam El-Din Osman,
Sudan International University, Sudan.
