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Cyanotic and Unresponsive: A Diagnostic Challenge in Alkyl Nitrite-Induced Methaemoglobinaemia

Year: 2025

Type: article

Abstract: Methaemoglobinaemia is a potentially serious condition in which haemoglobin is oxidised to a form that cannot carry oxygen effectively. Recreational inhalation of alkyl nitrites ("poppers") may precipitate this condition and can be overlooked when the presentation is sudden and severe. We report a 53-year-old male of Chinese ethnicity, with multiple comorbidities, including learning disabilities, who collapsed in public and presented unresponsive, cyanotic, hypothermic, and profoundly hypoxic despite high‑flow oxygen. Arterial blood gas analysis revealed a high methaemoglobin level with a normal arterial oxygen tension, producing a marked saturation gap. A bottle of alkyl nitrites found in his possession supported a toxic cause. Intravenous methylene blue led to rapid clinical and biochemical improvement, and the patient made a full recovery. Safeguarding measures were implemented due to his cognitive vulnerability. This case highlights the diagnostic challenge of unexplained hypoxia, the essential role of co‑oximetry in confirming methaemoglobinaemia, considerations for enzyme deficiencies like G6PD, and the importance of harm-reduction strategies amid rising poppers use.

Source: Cureus

DOI: 10.7759/cureus.98627

Authors: Sayantan Basu, Rayna Koshy, Verghese Kurien, Joseph Allen, Purba Chakrabarty

Institutions: Eastbourne District General Hospital, New Cross Hospital, The Royal Wolverhampton NHS Trust, East Sussex Healthcare NHS Trust

Language: English

Topic: Methemoglobinemia and Tumor Lysis Syndrome

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4417091592