On September 12, 2008, The US Food and Drug Administration (FDA) issued a Health Information Advisory after reports emerged from China regarding the presence of melamine in infant formula.  Over 12,000 children have been hospitalized, and 4 reportedly have died as a result of complications from melamine exposure through ingested formula.  Since then, a number of other countries have recalled other milk-based food products found to contain melamine.  Melamine, which artificially enhances the protein content of milk, is an industrial contaminant that can cause kidney stones and other serious urinary tract complications when ingested by humans.  The FDA stresses that there is no known threat of contamination of source materials in infant formula approved for manufacture or sale in the United States
(see www.fda.gov and click on “melamine contamination”).

Symptoms and signs of melamine poisoning may include irritability, blood in the urine, little or no urine, vomiting, flank pain, kidney stones, headaches, or high blood pressure.  If your child has any of these symptoms, please contact your primary care physician.  If you also have concerns that your adopted child may have been exposed to melamine-containing formula or milk products, you may contact the Adoption Health Service at 216-844-3224 for more information and to determine if your child needs further medical evaluation. 

MELAMINE EXPOSURE ALGORITHM for child of any age (10/7/08): 
HISTORY:
Born in or visited China between 2006-present
Born in or visited other Asian countries between 2006-present 
Drank Chinese-manufactured infant formula (either in China or other country) or milk products between 2006-present
Adopted from a country that may have imported Chinese milk products (N or S Korea, Indonesia, Taiwan, Singapore, Malaysia, Burundi, Gabon, Tanzania, Brunei, Philippines)
 
If History is NEGATIVE, do not need to be seen by us
If History is POSITIVE, Determine if clinically stable

CLINICAL STABILITY: (alert, eating, urinating adequately)
If UNSTABLE, Go to ED
If STABLE, see in clinic for further evaluation and assess for signs and symptoms

SIGNS/SYMPTOMS:

• Irritability
• Hematuria
• Decreased urine
• Flank pain
• History of kidney stones
• Hypertension

If Signs or Symptoms are ABSENT, proceed to Lab Evaluation I
If any Signs or Symptoms are PRESENT/POSITIVE, proceed to Lab Evaluation II

LAB EVALUATION I:
UA (?bag-easier to obtain, contaminant for bacteria—vs cath-risk of blood, more accurate for infection…)
Basic Metabolic Panel (BUN, creatinine, K, Na, HCo3)
 
If Lab Evaluation I is NORMAL, no further evaluation for melamine exposure is needed at this time and patient can follow up with primary care physician as needed.
If Lab Evaluation I yields any ABNORMAL results, consider obtaining a renal ultrasound and refer to Pediatric Nephrology (or Urology?)

LAB EVALUATION II:
UA
Basic Metabolic Panel
Renal Ultrasound

• If Lab Evaluation II is NORMAL, no further evaluation for melamine exposure is needed at this time and patient can follow up with primary care physician as needed.
  If Lab Evaluation II yields any ABNORMAL results, consider referral to Pediatric Nephrology (or Urology?)