If intoxication comes as a result of drinking water with a high content of nitrates, the first symptoms will appear within an hour. Information on this site is not an indication for treatment. Poisoning can result from swallowing, inhaling, or even skin contact. Why and how did the ammonium nitrate cause this woman to appear blue-gray? The clinical picture may be similar to toxic pneumonia. National Center for Environmental Health. Available at: Enter multiple addresses on separate lines or separate them with commas. Environ Health Perspect 2000;108:675-8. If the source is a private well, the water should be tested for nitrate. In children, chronic hypoxia causes a lag in mental and physical development, increased nervous irritability, impaired functioning of the heart and blood vessels, and a decrease in immunity to infectious diseases. The resulting compound, methemoglobin, is incapable of binding molecular oxygen and produces a leftward shift in the oxygen-dissociation curve, which results in hypoxemia. There seems to be little or no risk of nitrate poisoning from commercially prepared infant foods in the United States. However, diarrhea is usually absent. The condition is a form of nitrate poisoning. There have been occasional cases of nitrate poisoning in infants from ingestion of plant nitrates,8–13 only one of which was reported from the United States.9 Nitrates are natural constituents of plant material, and the effect of commercial nitrate-containing fertilizers on the nitrate content of vegetables is inconsistent.14 Because the intake of naturally occurring nitrates from foods such as green beans, carrots, squash, spinach, and beets can be as high as or higher than that from well water, these foods should be avoided before 3 months of age, although there is no nutritional indication to add complementary foods to the diet of the healthy term infant before 4 to 6 months of age.14,15 Some commercially prepared infant food vegetables are voluntarily monitored for nitrate content by private industry, including spinach, squash, and carrots. Fetal hemoglobin, the predominant form in infants up to 3 months of age, is oxidized more readily to methemoglobin by nitrite than is adult hemoglobin. There are signs of a hypoxic state of tissues: shortness of breath, palpitations, fatigue, cyanosis of the skin. All prenatal and well-infant visits should include questions about the home water supply. Use nitrate medications only as prescribed. Nitrate poisoning develops, the symptoms and treatment of which are similar to nitrite and nitrosamine poisoning. To speed up the elimination of nitrates from the body, you need to drink plenty of fluids! Affected infants may present with asymptomatic cyanosis, which can progress to dyspnea and lethargy or coma. Keep medications and household chemicals in their original containers and out of reach and sight of children. This is done through the nitrogen cycle, in which microorganisms in soil and plant roots convert nitrogen in the air we breathe to nitrates and nitrites. Nitrate poisoning resulting in methemoglobinemia continues to be a problem in infants in the United States. When significant concentrations of methemoglobin (>30%) are present, a pulse oximeter is very misleading and will detect only mild to moderate oxygen desaturations in the 82% to 86% range.20, Health care professionals who suspect that an infant has methemoglobinemia are advised to consult with the local poison control center or a toxicologist to help guide management. • For infants who are bottle-fed, nitrate poisoning can happen when nitrate contaminated drinking water is used to dilute formula. and explosives. What to do with nitrate poisoning? Infants fed commercially prepared infant foods generally are not at risk of nitrate poisoning. Nitrates convert to nitrites in the stomach by … Assign oxygen therapy. Terms of UseAbout UsCourse RegistrationPrivacy PolicyContact UsFeedbackMedical Toxicology Fellowship, Knobeloch L, Salna B, Hogan A, Postle J, Anderson H. Blue babies and nitrate-contaminated well water. Poisoning can also occur in infants fed home-prepared infant foods made of vegetables high in nitrate/nitrite content. Nitrate poisoning in children .  |  Eur J Emerg Med 2003;10:326-30. © 2012- Nitrates are salts of nitric acid. The severity of methemoglobinemia is directly proportional to the percentage of red blood cells affected. In severe cases, there are impaired functioning of the nervous system: pain in the back of the head, dizziness, drowsiness or anxiety, disorder of coordination, convulsions and coma. Adults Those with very mild methemoglobinemia might not have any symptoms at all, or might appear a little pale and feel tired. The old toxicology adage by the 16th century physician Paracelsus, "the dose makes the poison," truly applies to nitrates and nitrites. Intoxication can occur due to accidental ingestion of nitrogen fertilizers. Symptoms of nitrate poisoning can vary depending on the amount and duration of the exposure. When eating toxic vegetables and fruits, the first signs appear after four hours. In severe cases, with nitrate poisoning will need the help of a doctor. When digestive disorders apply sparing diet: eliminate harmful foods, pay attention to cereals and stewed vegetables, low-fat boiled meat. Breastfed infants are not at risk of nitrate poisoning from mothers who ingest water with high nitrate content (up to 100 ppm nitrate nitrogen), because nitrate concentration does not increase significantly in the milk. A target concentration of nitrate nitrogen for food of <100 ppm is desirable for infants. He had inadvertently inhaled the liquid and had also gotten some on his skin. As a result, a lack of oxygen and a dysfunction of all systems and organs, and in the first place - the cardiovascular system, develop. Symptoms of nitrate poisoning can vary depending on the amount and duration of the exposure. Water contamination. When poisoning with nitrates in children, the symptoms more indicate damage to the circulatory and nervous system: In infants, the most common source of nitrate exposure is well water, which is mixed with infant formula. You should immediately call an ambulance if: When nitrate poisoning treatment includes a set of measures to eliminate hypoxia, restore hemoglobin, accelerate the elimination of toxins from the body. Even though nitrates are vital to all plant and animal life, overexposure can lead to serious, negative health effects. Atlanta GA; 2015 [accessed Nov 30, 2017]. The two areas of possible concern are that (i) nitrate could be a precursor to nitrite in the lower gut, and nitrite is a precursor to nitrosamines, which are implicated in carcinogenesis, and (ii) nitrate is implicated in methemoglobinemia, a disorder of red blood cells hemoglobin.