Poppers-induced methemoglobinemia: an unusual cause of cyanosis

Ranchon, Guillaume; Mollard, Frédéric; Lainé, Nicolas; Malick, Peggy; Robert, Dominique

doi:10.1097/mej.0b013e3282fc7638

Cited by 11 publications

(14 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Usual side effects are reversible macula degeneration, but hemolytic anemia has also been reported [1,6]. Upon oral ingestion they potentially lead to methhemoglobinemia which needs to be treated with methylene blue [5]. Contact dermatitis secondary to alkyl nitrates has been described in the literature, but in clinical practice, the causation is rarely as obvious as in the case presented.…”

Section: Discussionmentioning

confidence: 85%

“…Originally, the substances were used for antianginal therapy in patients with coronary artery disease due to their vasodilating effects [2,3]. Besides the plausible hypothesis that "poppers" use is associated with high-risk sexual behavior [4], the most prominent unwanted side effects of its use are methemoglobinemia [5] and maculopathy [6]. Methemoglobinemia is usually caused by intentional or unintentional oral ingestion of the substance and treated by administration of methylene blue.…”

Section: Casementioning

confidence: 99%

See 1 more Smart Citation

The Untimely Popping Phial: Poppers as an Unusual Cause of Skin Corrosion of the Thigh

Moret

Lindner

Woitok

2020

Case Reports in Emergency Medicine

View full text Add to dashboard Cite

Background. Alkyl nitrites or “poppers” are widely used as sex-drugs due to their aphrodisiac and muscle relaxant effects. We describe the rare case of a large-sized dermatitis after direct skin contact with the poppers-fluid in a poppers user. Case Presentation. A 52-year-old patient presented to the emergency department due to burning pain on his proximal right thigh and scrotum. Clinical examination showed an 8 × 5 cm measuring burning wound resembling lesion. During further history the patient mentioned that the day before presentation a “poppers” phial unintentionally opened in his pocket and the fluid leaked. Conclusions. The present case shows severe skin defects after skin-contact with alkyl nitrates in a “poppers” user. Maculopathy and methemoglobinemia are prominent unwanted side effects of “poppers” use. However, our report demonstrates that attention should also be paid to potential harm for the skin.

show abstract

Section: Discussionmentioning

confidence: 85%

Section: Casementioning

confidence: 99%

The Untimely Popping Phial: Poppers as an Unusual Cause of Skin Corrosion of the Thigh

Moret

Lindner

Woitok

2020

Case Reports in Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Amyl nitrite causes a short lived euphoric feeling due to its ability to dilate blood vessels as well as induce tachycardia. It has also been suggested that amyl nitrite enhances sexual pleasure [9]. No laboratory assay is readily available to measure amyl nitrite levels.…”

Section: Discussionmentioning

confidence: 99%

A Case of Severe Amyl Nitrite Induced Methemoglobinemia Managed with Methylene Blue

Faley¹

2012

J Clin Toxicol

View full text Add to dashboard Cite

Introduction: It is well documented that amyl nitrite can cause methemoglobinemia [1-7]. This condition can be successfully treated with methylene blue therapy [1-8]. Amyl nitrite is used therapeutically as part of the antidote cocktail to treat cyanide poisoning; however, it also carries a high abuse potential. Case Report: A 45 year old male with a history of hypertension, polysubstance abuse, and anxiety was found unconscious. Upon Arterial Blood Gas (ABG) collection, the blood appeared chocolate brown and a methemoglobin level of 75.4% was revealed along with a carboxyhemoglobin level of zero. Methylene blue was administered as a single weight based bolus and the patient's methemoglobin level eventually returned to normal. Discussion: Many drugs are known to cause methemoglobinemia, but few are abused. An exception is amyl nitrite. Recently, the Food and Drug Administration (FDA) issued a safety notice [5] warning practitioners about the risk of serotonin syndrome when methylene blue is utilized concomitantly with medications exhibiting serotonergic effects. Conclusion: In light of the new safety warning issued by the FDA, the clinician should be familiar with the dosing and administration of methylene blue as well the appropriate ways to manage or avoid potentially serious adverse events associated with its use.

show abstract

“…The majority of these cases survived, and a proportion were treated with methylthioninium chloride. The cases where the individual survived are summarized in Table 2[1–21] and the three reported deaths are discussed in more detail later in this article [22–24]. For the interest of the reader, we have discussed three of the non‐fatal cases in more detail below.…”

Section: Volatile Nitrite‐related Methaemoglobinaemiamentioning

confidence: 99%

“…Subsequent to this, there have been 25 reports of methaemoglobinaemia secondary to inhalation and/or ingestion of volatile nitrites, with methaemoglobin concentrations of between 17.8% and 94% [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. The majority of these cases survived, and a proportion were treated with methylthioninium chloride.…”

Section: Volatile Nitrite-related Methaemoglobinaemiamentioning

confidence: 99%

Methaemoglobinaemia associated with the use of cocaine and volatile nitrites as recreational drugs: a review

Hunter

Gordge

Dargan

et al. 2011

Brit J Clinical Pharma

View full text Add to dashboard Cite

Methaemoglobinaemia can cause significant tissue hypoxia, leading to severe, potentially life-threatening clinical features and/or death. Over recent years there have been increasing reports of methaemoglobinaemia related to recreational drug use. There have been 25 articles describing methaemoglobinaemia related to recreational use of volatile nitrites (poppers) and more recently, four reports of methaemoglobinaemia in association with recreational cocaine use. In this article we discuss the mechanisms by which methaemoglobinaemia occurs in relation to the use of both volatile nitrites and cocaine, and summarize the published cases of recreational drug-related methaemoglobinaemia. The volatile nitrites can cause methaemoglobinaemia directly through their activity as oxidizing agents. However, with cocaine, methaemoglobinaemia is related to adulterants such as local anaesthetics or phenacetin, rather than to the cocaine itself. Clinicians managing patients with acute recreational drug toxicity should be aware of the potential for methaemoglobinaemia in these patients, particularly in patients with cyanosis or unexplained low oxygen saturations on pulse oximetry, and ensure that appropriate and timely management is provided, including, where appropriate, the use of methylthioninium chloride (methylene blue).

show abstract

Poppers-induced methemoglobinemia: an unusual cause of cyanosis

Cited by 11 publications

References 4 publications

The Untimely Popping Phial: Poppers as an Unusual Cause of Skin Corrosion of the Thigh

The Untimely Popping Phial: Poppers as an Unusual Cause of Skin Corrosion of the Thigh

A Case of Severe Amyl Nitrite Induced Methemoglobinemia Managed with Methylene Blue

Methaemoglobinaemia associated with the use of cocaine and volatile nitrites as recreational drugs: a review

Contact Info

Product

Resources

About