Gray baby syndrome
| Gray baby syndrome | |
|---|---|
| Classification and external resources | |
| ICD-10 | P93 |
| ICD-9 | 779.4 |
| MedlinePlus | 007049 |
Gray baby syndrome (also termed Gray or Grey syndrome) is a rare but serious side effect that occurs in newborn infants (especially premature babies) following the intravenous administration of the antimicrobial chloramphenicol.[1]
Contents |
Pathophysiology [edit]
Two pathophysiologic mechanisms are thought to play a role in the development of gray baby syndrome after exposure to the anti-microbial drug chloramphenicol. This condition is due to a lack of glucuronidation reactions occurring in the baby, thus leading to an accumulation of toxic chloramphenicol metabolites. :[2]
- The UDP-glucuronyl transferase enzyme system of infants, especially premature infants, is immature and incapable of metabolizing the excessive drug load.
- Insufficient renal excretion of the unconjugated drug.
Clinical features [edit]
Toxic levels of chloramphenicol after 2–9 days result in:
- Vomiting
- Ashen gray color of the skin
- Limp body tone
- Hypotension (low blood pressure)
- Cyanosis blue discolouration of lips and skin.
- Hypothermia
- Cardiovascular collapse
Treatment [edit]
Chloramphenicol therapy is discontinued immediately; exchange transfusion may be required to remove the drug. Sometimes, phenobarbital (UGT induction) is used.
Prevention [edit]
The condition can be prevented by using chloramphenicol at the recommended doses and monitoring blood levels,[3][4][5] or alternatively, third generation cephalosporins can be effectively substituted for the drug, without the associated toxicity.[6]
References [edit]
- ^ McIntyre J, Choonara I (2004). "Drug toxicity in the neonate.". Biol Neonate 86 (4): 218–21. doi:10.1159/000079656. PMID 15249753.
- ^ Brunton, Laurence L. (Ed.) (2006). "Chapter 46. Protein Synthesis Inhibitors and Miscellaneous Antibacterial Agents". Goodman & Gilman's The Pharmacological Basis of Therapeutics (11th ed.). McGraw-Hill. ISBN 0-07-142280-3.
- ^ Feder H (1986). "Chloramphenicol: what we have learned in the last decade.". South Med J 79 (9): 1129–34. doi:10.1097/00007611-198609000-00022. PMID 3529436.
- ^ Mulhall A, de Louvois J, Hurley R (1 January 1983). "Chloramphenicol toxicity in neonates: its incidence and prevention." (Scanned copy & PDF). Br Med J (Clin Res Ed) 287 (6403): 1424–7. doi:10.1136/bmj.287.6403.1424. PMC 1549666. PMID 6416440.
- ^ Forster J, Hufschmidt C, Niederhoff H, Künzer W (1985). "[Need for the determination of chloramphenicol levels in the treatment of bacterial-purulent meningitis with chloramphenicol succinate in infants and small children]". Monatsschr Kinderheilkd 133 (4): 209–13. PMID 4000136.
- ^ Aggarwal, R.; Sarkar, N.; Deorari, A.K.; Paul, V.K. (2001). "Sepsis in the newborn". Indian Journal of Pediatrics 68 (12): 1143–1147. doi:10.1007/BF02722932. PMID 11838570. Retrieved 2008-05-03.
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