gray baby syndrome
Summary
Gray baby syndrome is a potentially fatal condition caused by chloramphenicol toxicity in neonates, characterized by gray skin discoloration, cardiovascular collapse, and high mortality. It occurs due to immature hepatic glucuronyl transferase enzyme systems in newborns, leading to drug accumulation and toxicity.
Detail
Gray baby syndrome is a serious adverse reaction to chloramphenicol that primarily affects neonates and infants under 2 months of age. The pathophysiology involves the immature hepatic conjugation system in newborns, specifically deficient glucuronyl transferase activity, which prevents adequate metabolism and clearance of chloramphenicol. This leads to drug accumulation and toxicity. Clinical manifestations include the characteristic gray-blue skin discoloration (cyanosis), abdominal distension, vomiting, loose stools, progressive pallor, vasomotor collapse, and irregular respiration. The syndrome typically develops 2-9 days after initiation of therapy and has a mortality rate of approximately 40%. The mechanism involves mitochondrial toxicity and inhibition of protein synthesis. Treatment is supportive, focusing on discontinuation of chloramphenicol and symptomatic management. This syndrome led to restricted use of chloramphenicol in pediatric populations and emphasizes the importance of age-appropriate drug dosing based on hepatic maturity.
Sources
- Goodman & Gilman's The Pharmacological Basis of Therapeutics
- Nelson Textbook of Pediatrics
- Katzung Basic & Clinical Pharmacology
- USMLE First Aid for the USMLE Step 1
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