POPPERS - A RARE CAUSE OF METHEMOGLOBULINEMIA OBSERVED IN THE EMERGENCY ROOM

BACKGROUND: Methemoglobulinemia should be entertained as a differentia l diagnosis in patients with cyanosis, Recently in France there has be en an increase in the number of cases of acquired methemaglobulinemia due to inhalation of poppers. CASE REPORTS: Four patients were admitte d to the emergency room of a Paris hospital in a stale oi unconsciousn ess with cyanosis. All four patients had inhaled poppers shortly befor e admission. The clinical course was rapidly favorable after intraveno us infusion of methylene blue in 3 cases. DISCUSSION: Poppers are inor ganic aliphatic nitrites used for their relaxing effect on smooth musc le and for their aphrodisiac effect. One poorly recognized effect is t he development of methemoglobulinemia. Tissue hypoxia results because methemoglobulin cannot bind oxygen, leading to a brown or blue colorat ion of the blood, Methemoglobulin usually results from exposure to a w ide variety of oxidizing compounds including certain drugs. Methylene blue is the specific treatment for symptomatic methemoglobulinemia. Th ese four cases Emphasize the toxic effect of products sold in sex shop s and calls attention to the life-threatening risks involved.