SHM Converge Scientific Abstract ePoster Gallery-Severe Methemoglobinemia Following Recreational Nitrite Ingestion: A Case of Toxic Encephalopathy and Hemodynamic Instability

Severe Methemoglobinemia Following Recreational Nitrite Ingestion: A Case of Toxic Encephalopathy and Hemodynamic Instability

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This case report describes a 67-year-old man who developed severe methemoglobinemia after ingesting “Super Rush,” a recreational product containing isobutyl nitrite. He was found unresponsive in a hotel room with the substance nearby and presented with bradycardia, hypotension, hypoxia, and worsening mental status. In the emergency department, he initially improved with high-flow oxygen but then became obtunded and more hypotensive, requiring intubation and vasopressor support.<br /><br />Laboratory testing confirmed methemoglobinemia with a methemoglobin level of 37.5%, along with acute kidney injury. He was treated promptly with 150 mg of methylene blue, which lowered his methemoglobin level to 21.1%. He was then admitted to the medical intensive care unit for toxic encephalopathy and hemodynamic instability secondary to methemoglobinemia.<br /><br />The report explains that nitrites, often used recreationally as “poppers,” are oxidizing agents that convert normal hemoglobin into methemoglobin, reducing the blood’s ability to carry oxygen. This can cause symptoms ranging from cyanosis to altered mental status, severe hypoxia, and cardiovascular instability. Diagnosis is confirmed by co-oximetry, and treatment with methylene blue is the first-line therapy because it restores hemoglobin function through the NADPH-dependent pathway.<br /><br />The authors emphasize that severe methemoglobinemia is a life-threatening complication of nitrite ingestion and that rapid recognition and treatment are essential. They also highlight the broader public health concern posed by the easy availability and misuse of nitrite-containing products.

Asset Subtitle

Danyaal Jafrani

Meta Tag

Author List Benjamin Hsieh, Danyaal Jafrani, Prit A. Patel

Category Clinical Vignettes

Concept Nitrite Ingestion

Concept Methemoglobinemia

Concept Methylene Blue

Concept Oxygen Delivery

Concept Co-oximetry

Distinguished Non-Finalist

Presenter Organization Rutgers NJMS

Presenting Author Danyaal Jafrani

Track Adult

Keywords

methemoglobinemia

isobutyl nitrite

methylene blue

nitrite ingestion

recreational drug

hypoxia

toxic encephalopathy

co-oximetry

acute kidney injury

vasopressor support

Nitrite Ingestion

Methemoglobinemia

Methylene Blue

Oxygen Delivery

Co-oximetry