Severe methemoglobinemia secondary to isobutyl nitrite toxicity: the case of the ‘Gold Rush’

Author:

Taylor Gregory M1ORCID,Avera Robert S2,Strachan Christian C3,Briggs Christian M4,Medler Jason P1,Pafford Carl M1,Gant Timothy B5

Affiliation:

1. Assistant Professor of Clinical Emergency Medicine, Indiana University School of Medicine; IU Health Ball Memorial Hospital, Muncie, IN, USA

2. Toxicology Fellow, Indiana University School of Medicine, Indianapolis, IN, USA

3. Executive Vice Chair of Clinical Affairs, Assistant Professor of Clinical Emergency Medicine, Indiana University School of Medicine; East Central Region Emergency Department Medical Director, Indianapolis, IN, USA

4. Resident, Indiana University School of Medicine; IU Health Ball Memorial Hospital, Muncie, IN, USA

5. Emergency Department Nurse; IU Health Ball Memorial Hospital, Muncie, IN, USA

Abstract

ABSTRACT Isobutyl nitrite is one of the popular recreational drugs with high abuse potential that is known to cause methemoglobinemia. While inhaling this recreational drug, often referred to as a ‘popper’, is the typical route of administration, oral ingestion can produce a more rapid and fulminant course of methemoglobinemia. We present the case of a 69-year-old male that presented to our emergency department in extreme, life-threatening methemoglobinemia due to the ingestion of isobutyl nitrite that he obtained from an adult novelty store. The patient had a methemoglobin level above our lab cut-off of 28% and was subsequently treated with two doses of intravenous methylene blue. His hospital course was unremarkable, and he was discharged on Day 2. Methemoglobinemia is a medical emergency that requires a high index of clinical suspicion, prompt recognition, and rapid treatment.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology,Parasitology

Reference10 articles.

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4. Two cases of Methemoglobinemia induced by the exposure to nitrobenzene and aniline;Hwan;Ann Occupational Environ Med,2013

5. Code blue: life-threatening Methemoglobinemia. Clinical practice cases;Ponce;Emerg Med,2019

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