C53-29 Severe Methemoglobinemia Following Oral Ingestion of Amyl Nitrite

Abstract Introduction Amyl nitrite is a volatile alkyl nitrite known as “poppers”; when used recreationally, they promote states of euphoria and vasodilation. Reports of methemoglobinemia associated with poppers appear to be rising, yet oral ingestion remains underrecognized. We describe a case of severe methemoglobinemia requiring intensive care management following accidental oral ingestion of poppers. Case 46-year-old man with a history of post-traumatic stress disorder and anxiety presented after mistakenly drinking poppers. Given its similar appearance to common energy drinks, he assumed a similar route of administration. He immediately became dizzy, diaphoretic, dyspneic, nauseous, had profuse vomiting, and presented to the emergency department. Upon arrival, he was persistently hypoxic despite non-rebreather mask and high-flow nasal cannula. Laboratory testing revealed a methemoglobin level of 45.3% concerning for severe methemoglobinemia. He ultimately required two separate doses of methylene blue (1 mg/kg each), leading to rapid resolution of symptoms and normalization of oxygen saturation. After overnight monitoring in the ICU without any additional doses of methylene blue, he was stable for transfer and discharge. Discussion This case highlights the rising frequency of unintentional life-threatening methemoglobinemia after oral ingestion of nitrite-containing products. Prompt recognition and timely treatment by medical personnel can prevent intubation and prolonged ICU care. There is now also the need for increased public health measures such as clearer labeling, stricter regulations and targeted education to mitigate unintentional ingestion This abstract is funded by: none