Jungle juice causing pseudohypercholesterolaemia

Abstract

Background: A twenty-one-year old female presented to the emergency department with cyanosed lips after consuming 3– 5mL of Jungle Juice (pentyl nitrite) with seven standard drinks of ethanol over the course of six hours. Her skin appeared grey suggesting progressive hypoxaemia, blood paracetamol level was undetectable and urine drug screen (Roche Cobas c501) was negative for cannabinoids, barbiturates, amphetamines and opiates. Methylene blue was commenced immediately and a follow-up venous blood gas fourr hours after admission (Radiometer ABL 800) showed pH: 7.35, pO2: 20.4 mmHg, pCO2: 46.0 mmHg, Na: 143 mmol/L, K: 4.2 mmol/L, Cl: 119 mmol/L, bicarbonate: 24.8 mmol/L, creatinine: 92 umol/L, ionised Ca: 1.18 mmol/L and glucose: 5.4 mmol/L. Paired peripheral venous sample performed on the Roche Cobas c501 for electrolytes gave similar results, but the chloride was significantly different: 104 mmol/L. The calculated anion gap (AG) resulting from the ABL 800 is falsely low 3 (7–17), compared to 22 (7–17) from the Roche Cobas c501. Conclusion: This illustrates that nitrate from the metabolism of pentyl nitrite may be preferentially selected by chloride electrodes impregnated with certain ionophores, causing falsely high chloride levels. In an unconscious patient, this presents a challenge to clinicians to determine the cause.