[Poisoning with "poppers", a rare cause of methemoglobinemia observed in emergency cases].
BACKGROUND
Methemoglobulinemia should be entertained as a differential diagnosis in patients with cyanosis. Recently in France there has been an increase in the number of cases of acquired methemoglobulinemia due to inhalation of poppers.


METHODS
Four patients were admitted to the emergency room of a Paris hospital in a state of unconsciousness with cyanosis. All four patients had inhaled poppers shortly before admission. The clinical course was rapidly favorable after intravenous infusion of methylene blue in 3 cases.


CONCLUSIONS
Poppers are inorganic aliphatic nitrites used for their relaxing effect on smooth muscle and for their aphrodisiac effect. One poorly recognized effect is the development of methemoglobulinemia. Tissue hypoxia results because methemoglobulin cannot bind oxygen, leading to a brown or blue coloration of the blood. Methemoglobulin usually results from exposure to a wide variety of oxidizing compounds including certain drugs. Methylene blue is the specific treatment for symptomatic methemoglobulinemia. These four cases emphasize the toxic effect of products sold in sex shops and calls attention to the life-threatening risks involved.
Staïkowsky
F
F
Service des Urgences, Hôpital Rothschild, Paris.
Perret
A
A
Péviriéri
F
F
Zanker
C
C
Zerkak
D
D
Pelloux
P
P
Danhiez
F
F
D000328:Adult; D001046:Aphrodisiacs / Q000506:poisoning*; D004630:Emergencies; D005602:France / Q000453:epidemiology; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology; D008297:Male; D008708:Methemoglobinemia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D008751:Methylene Blue / Q000627:therapeutic use; D008875:Middle Aged; D009573:Nitrites / Q000506:poisoning
D001046:Aphrodisiacs; D009573:Nitrites; D008751:Methylene Blue