Skin discoloration with blue food coloring

Alan J. Zillich, Robert J. Kuhn, Thomas J. Petersen

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


OBJECTIVE: To describe a pediatric patient who developed a clinical cyanotic appearance after receiving an excessive amount of blue food coloring. CASE SUMMARY: An 11-year-old white girl with cerebral palsy was admitted for unresolving aspiration pneumonia and dehydration. Antibiotics and intravenous fluids were administered. During the hospital course, enteral nutrition containing blue food coloring was also administered. Twelve hours after the start of enteral nutrition, the patient appeared cyanotic despite a regular respiratory rate and normal oxygen saturation. The pediatric code response team was called. Enteral nutrition was stopped and then restarted without blue food coloring. Over the next 24 hours, the cyanotic appearance resolved and no further complications developed. DISCUSSION: At our institution, blue food coloring is used with enteral nutrition for detecting aspiration of stomach contents. The dietary department supplies food coloring to each nursing unit in pint-sized medicine bottles. Nurses place an unstandardized amount of blue food coloring into each enteral nutrition bag. This child received an unspecified amount of FD and C Blue No. 1 food coloring. No toxicity studies exist for acute or human ingestion, but the National Academy of Sciences lists 363 mg/d of FD and C Blue No. 1 as a safe level for humans. We estimated this child ingested 780-3940 mg of dye over a 12-hour period. CONCLUSIONS: This is the first known report of an adverse effect from blue food coloring. To prevent similar occurrences within our institution, the blue food coloring for tube feedings will be dispensed by the pharmacy department in standardized units.

Original languageEnglish
Pages (from-to)868-870
Number of pages3
JournalAnnals of Pharmacotherapy
Issue number7-8
StatePublished - 2000

Bibliographical note

Funding Information:
En esta institución, el colorante azul para alimentos es usado en la nutrición enteral para detectar aspiración del contenido gástrico. El departamento de dietas suple el colorante a cada unidad de enfermería en botellas de una pinta. El personal de enfermería coloca una cantidad no estandarizada del colorante azul en cada uno de los tubos de alimentación. Esta niña recibió una cantidad no especificada del colorante de alimentos FD&C Azul No. 1. No existen estudios de toxicidad sobre la ingestión aguda o en humanos de este colorante. Sin embargo, la Academia Nacional de Ciencias recomienda 363 mg/día del colorante FD&C Azul No. 1 como un nivel seguro para el hombre. Los autores estimaron que la niña ingirió de 780 a 3940 mg del tinte en un período de 12 horas.


  • FD and C Blue No. 1
  • Food coloring
  • Toxicity

ASJC Scopus subject areas

  • Pharmacology (medical)


Dive into the research topics of 'Skin discoloration with blue food coloring'. Together they form a unique fingerprint.

Cite this