From Poppers to Peril: Recreational Nitrite-Induced Methemoglobinemia

• Published in: Curēus (Palo Alto, CA) Vol. 16; no. 8; p. e67435
• Main Authors: Alkhateeb, Wasef, Luthra, Gaurav, Almatroud, Lanah, Saleh, Alyaa, Landa, Elise
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 21.08.2024; Cureus
• Subjects: Acidosis; Blood tests; Cyanosis; Cytochrome; Enzymes; Hematology; Hemoglobin; Metabolism; Nitrates; Oxidation; Oxygen saturation; Pulmonology; Skin; Solvent abuse; Substance Use and Addiction; Urine; methylene blue; poppers; methemoglobinemia; inhalant abuse; inhaled nitrites; green urine; substance abuse
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.67435

Inhaled amyl nitrites, once used to alleviate chest pain, are more commonly now being used for their euphoric effects. The recreational use of inhaled nitrites can lead to methemoglobinemia, a life-threatening condition that hinders the utilization of oxygen in the body. In 2021, 2.2 million people aged 12 or older used inhalants in the past year. Methemoglobinemia has favorable outcomes with treatment. We present the case of a 43-year-old man, with a medical history of type 2 diabetes mellitus and hypertension presenting with bluish discoloration of the fingers that progressed to his tongue and lips. He disclosed using a recreational inhalant called "Rush" before coming in. Vital signs showed low oxygen saturation on room air, and further investigation revealed elevated methemoglobin levels on the venous blood gas. Methylene blue was used for treatment, with complete resolution of the patient's symptoms and the only side effect of green urine. The patient was later discharged home in a stable condition. History taking is a crucial part of managing methemoglobinemia, as presentation to the clinical setting could vary. Our case presents the milder version of the disease with quick complete recovery after appropriate treatment. It demonstrates inhalant abuse in a less common age group. The case also demonstrates a common side effect of methylene blue that is often forgotten.