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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2021  |  Volume : 32  |  Issue : 5  |  Page : 1497-1498
A child with central cyanosis and acute kidney injury: A clinical spotter


1 Department of Pediatric Nephrology, Dr. M R Khan Children's Hospital and Institute of Child Health, Dhaka, Bangladesh
2 Department of Pediatric Nephrology, Kidney Institute, Medanta The Medicity, Gurgaon, Haryana, India
3 Department of Pediatric Nephrology, Akron Children's Hospital, Ohio, Cleveland, USA

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Date of Web Publication4-May-2022
 

How to cite this article:
Sultana A, Sethi SK, Ghosh NK, Raina R. A child with central cyanosis and acute kidney injury: A clinical spotter. Saudi J Kidney Dis Transpl 2021;32:1497-8

How to cite this URL:
Sultana A, Sethi SK, Ghosh NK, Raina R. A child with central cyanosis and acute kidney injury: A clinical spotter. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2022 Jun 28];32:1497-8. Available from: https://www.sjkdt.org/text.asp?2021/32/5/1497/344777


To the Editor,

An 8-year-old boy was brought to the clinic with complaints of central cyanosis, dyspnea on exertion, and chest tightness, off and on since his four years of age. There was no significant family history. Currently, he had fever with chills and rigors for the past three days and dark red-colored urine for the past two days. On examination, the child was cyanosed and hypertensive (blood pressure 108/80 mm Hg). His saturation on pulse oximetry was 62%. There were no obvious lung and heart issues noted on clinical examination and later confirmed by normal chest X-ray and echocardiography. Relevant laboratory evaluation showed hemoglobin 15.6 g/dL, blood urea 44 mg/dL; serum creatinine level 1.4 mg/dL, and serum bilirubin 4.2 mg/dL (indirect 2.5 mg/dL). Urine was dark-colored, with no RBCs on light microscopy and hem positive.

The child’s blood had a characteristic chocolate-brown color exposed to air [Figure 1]. Low oxygen saturation by pulse oximetry [Figure 2]a with normal arterial blood gases (pO2 168 torr) [Figure 2]b indicated possibility methemoglobinemia. His methemoglobin (methHb) level measured by co-oximetry was 46% which was elevated.
Figure 1: Characteristic chocolate-brown–colored blood on exposed to air.

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It is important to highlight that methHb levels can be overlooked in the routine arterial blood gases by the referring centers. Prompt recognition of the condition with co-oximetry and initiation of treatment, especially in cases of acquired methemoglobinemia, is critical in the management of these cases. To conclude, arterial blood gas may be a useful indicator for methemoglobinemia and should be analyzed for methHb levels in an undiagnosed case of cyanosis with a structurally normal heart and acute kidney injury.


   Teaching Points Top


  • Development of central cyanosis in the presence of a normal arterial pO2 and/or the presence of “chocolate-brown blood” in a patient with acute kidney injury is an important clinical clue to methemoglobinemia
  • Co-oximetry can help in the prompt confirmation of the diagnosis of methemoglobinemia.


Conflict of interest: None declared.



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Correspondence Address:
Azmeri Sultana
Department of Pediatric Nephrology, Dr. M R Khan Children's Hospital and Institute of Child Health, Dhaka
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-2442.344777

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    Figures

  [Figure 1], [Figure 2]



 

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