Acquired methemoglobinemia secondary to oral ingestion of alkyl nitrite

Authors

• Larissa L. Tavares, Memorial Healthcare System
• David Neff, Memorial Healthcare System
• Christopher Didonato, Memorial Healthcare System
• Atul Sofat, Memorial Healthcare System
• Eric Boccio, Mount Sinai Medical CenterFollow

ORCiD

Eric Boccio 0000-0003-1661-9695

Document Type

Case Report

Abstract

Methemoglobinemia is a potentially life-threatening condition in which the ferric state of hemoglobin impairs oxygen transport, leading to refractory hypoxia. While most cases are acquired through exposure to oxidizing agents, this report details a rare case of acquired methemoglobinemia complicated by severe hypotension and pulmonary edema secondary to the oral ingestion of alkyl nitrite, colloquially known as a “popper.”

A 54-year-old male presented to the emergency department after orally ingesting an alkyl nitrite product, believing it would be more effective than inhalation. Shortly after, he developed dizziness, dyspnea, and dusky skin, and was found to be hypotensive and hypoxic. Initial arterial blood gas analysis revealed a methemoglobin level of 29.9% [<1.5%] and a chest X-ray showed diffuse bilateral pulmonary edema. The patient was treated with intravenous methylene blue and was admitted to the medical intensive care unit for hypoxic respiratory failure and hypotension. After a second dose of methylene blue and further supportive care, his symptoms resolved and he was discharged on hospital day 4. This case is notable for the unusual route of exposure and the development of severe pulmonary edema, an uncommon complication of methemoglobinemia.

Recommended Citation

Tavares, Larissa L.; Neff, David; Didonato, Christopher; Sofat, Atul; and Boccio, Eric (2025) "Acquired methemoglobinemia secondary to oral ingestion of alkyl nitrite," Florida Journal of Emergency Medicine (FJEM): Vol. 2.
Available at: https://stars.library.ucf.edu/fjem/vol2/iss1/10