Abuse of Poppers: Four Cases of Methemoglobinemia Observed in an Emergency Room

Abstract

Abstracts -12th World Congress on Disaster and Emergency Medicine, Lyon, France departments (n = 17). Most often, a nurse undertook daily (71%) or weekly (14%) systematic verification of endotracheal intubation equipments in 87 emergency departments (94.6%). The necessary drugs for the performance ofendotracheal intubation and that were present in emergency rooms were: (1) midazolam, 100%; (2) diazepam, 98.9%; (3) thiopental, 83.3; (4) propofol, 83.3%; (5) fentanyl, 81.1%; (6) succinylcholine, 77.8%; (7) etomidate, 77.8%; (8) ketamine, 57.8%; vecuronium, 55.6%; (9) rocuronium, 31.1%; and (10) other non-depolarizing agents, 26.7%. In case of difficult airway management, the emergency practitioners found these other supplies available in emergency rooms: (1) kit for cricothyroidotomy, 69.7%; (2) catheter for percutaneous transtracheal ventilation ; (3) kit for retrograde intubation, 21.3%; (4) intubating laryngeal mask airway, 21.3%; (5) combitube, 14.6%; (6) fibroscope, 14.6%; and (7) fast-track, 12.4%. Conclusion: Anaesthetic agents are present in most of emergency departments. These emergency departments are less equipped with equipment and supplies for difficult airway techniques. The presence of airway management protocols or guidelines are rare. However, in France, it is necessary to improve the endotracheal intubation training of emergency physicians. In this training, the practitioners also must learn rapid sequence intubation (RSI), which is a standard emergency department procedure, and new airway devices such as the intubating laryngeal mask airway and a Bullard laryngoscope bade.

Aphrodisiacs past and present: A historical review

“…At the recommended doses, no toxicity is known. Inhalation of "poppers" containing aliphatic nitrates produces smooth muscle relaxation, hence vasodilatation and improved potency [21]. Methemoglobinemia, an underestimated side effect, can be fatal.…”

Methemoglobinemia due to use of poppers: a case report

“…Methemoglobin is an oxidized form of hemoglobin where ferrous iron Fe 2+ is converted to ferric iron Fe 3+ , making it unsuitable for oxygen (O 2 ) transport [ 2 – 5 , 8 ]. During normal metabolism, a slight proportion of methemoglobin exists in the blood, for example, 1% in adults, 1.5% in newborns, and 2% in premature babies.…”

“…Methemoglobinemia is a condition in which iron in hemoglobin is oxidized from the ferrous state to the ferric state, making it unfit to carry oxygen throughout the body [ 1 – 5 ]. It can be caused by various factors, either congenital or by intoxication.…”

“…We decided to publish this case report because of the rarity of this pathology and given the incidence of poppers use, especially among the male homosexual population [ 3 , 5 , 6 ]. It is a medical emergency whose clinical presentation is characteristic and will allow a rapid diagnosis, with appropriate treatment leading to a favorable prognosis.…”

Use of Poppers (Amyl Nitrite): Unpleasant Side Effects in a Brothel

“…Their use supposedly leads to increased sexual pleasure and prolonged orgasm and is legal in Switzerland. Only a few cases of MHB induced by poppers are documented [6][7][8].…”