Near-fatal methemoglobinemia after recreational inhalation of amyl nitrite aerosolized with a compressed gas blower.
Adverse effects associated with recreational inhalation of nitrites are usually mild and rarely life-threatening. We report a rare case of near-fatal methemoglobinemia after inhalation of amyl nitrite after aerosolizing the liquid using a compressed gas blower designed to clean photographic equipment that employed hydrofluoroalkane-134a as a propellant. A 31-year-old previously healthy male became dyspneic and fainted soon after the recreational inhalation of amyl nitrite aerosolized using a compressed gas blower. He was brought to the emergency department with severe cyanotic appearance and profound shock. Oxygen saturation was 82%, unresponsive to oxygen supply. His methemoglobin blood level was 52.2%. After 100 mg of methylene blue (2 mg/kg body weight) was administered intravenously, he recovered consciousness, and dyspnea and cyanosis subsided gradually. This case illustrates the extraordinary hazard of the use of a compressed gas blower in the recreational inhalation of nitrites. Prompt recognition and rapid antidotal treatment may adequately correct near-fatal overdose associated with recreational use of amyl nitrite.
Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Chih-Hao
CH
Lin
Cheng-Chung
CC
Fang
Chien-Chang
CC
Lee
Patrick Chow-In
PC
Ko
Wen-Jone
WJ
Chen
D000328:Adult; D000336:Aerosols; D000680:Amyl Nitrite / Q000506:poisoning*; D006801:Humans; D013287:Illicit Drugs / Q000506:poisoning*; D008297:Male; D008708:Methemoglobinemia / Q000139:chemically induced* / Q000188:drug therapy; D008751:Methylene Blue / Q000627:therapeutic use
D000336:Aerosols; D013287:Illicit Drugs; D000680:Amyl Nitrite; D008751:Methylene Blue