Abstract
It is well documented that amyl nitrite can cause methemoglobinemia [1-7]. This condition can be successfully treated with methylene blue therapy [1-8]. Amyl nitrite is used therapeutically as part of the antidote cocktail to treat cyanide poisoning; however, it also carries a high abuse potential
Highlights
DiscussionMany drugs are known to cause methemoglobinemia, but few are abused. An exception is amyl nitrite
It is well documented that amyl nitrite can cause methemoglobinemia [1,2,3,4,5,6,7]
Previous case reports have shown that methemoglobin levels of greater than 70% require multiple doses of methylene blue therapy [4, 7]
Summary
Many drugs are known to cause methemoglobinemia, but few are abused. An exception is amyl nitrite. No laboratory assay is readily available to measure amyl nitrite levels Given this high abuse potential, it is surprising that there were fewer than 60 calls to poison control centers in the US during 2009 related to the use of poppers [2]. In July 2011, the Food and Drug Administration (FDA) issued a safety notice [5] warning practitioners about the risk of serotonin syndrome when methylene blue is utilized concomitantly with medications exhibiting serotonergic effects such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors, and others. No work up was under taken to asses for genetic abnormalities that may have explained why only 2 inhalations may have caused such an abnormally elevated methemoglobin level Another caveat to this case has to due with the use of single dose methylene blue. Clinicians should not expect to see the same results with methylene blue for longer acting agents known to cause methemoglobinemia such as the topical anesthetics or dapsone
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