Methemoglobinemia due to use of poppers: a case report.

BACKGROUND: Methemoglobinemia is an excess of oxidized hemoglobin in the blood, affecting oxygen transportation. It is characterized by central cyanosis that does not respond to oxygen therapy. Prognosis is excellent when treated adequately and rapidly. We present a case report of a 38-year-old Caucasian man suffering from methemoglobinemia due to the use of poppers. CASE PRESENTATION: A 38-year-old Caucasian man known as a smoker and addicted to cocaine was admitted to the emergency department with dyspnea, agitation, and central cyanosis that started approximately 3 hours before admission. The persistent hypoxia despite high-flow oxygen therapy and a history of poppers use helped to reveal a condition known as methemoglobinemia. CONCLUSIONS: Our case highlighted a typical clinical presentation of methemoglobinemia. This possible life-threatening condition can occur after ingestion or inhalation of poppers, commonly sold in sex shops for recreational purposes. This can be easily confirmed by the methemoglobin level of the blood gases, provided the emergency physician considers this diagnosis. Rapid treatment with intravenous methylene blue is effective and leads to a favorable prognosis.

Persistent hyperlactatemia in decompensated type I diabetes with hepatic glycogenosis and hepatomegaly: Mauriac syndrome: a case report.

BACKGROUND: We describe a case of Mauriac syndrome, which is a rare complication of poorly controlled type I diabetes that combines glycogenosis, hepatomegaly, growth retardation with a Cushingoid appearance that is most often present in children but also in young adults. Here we also describe another finding with this syndrome, which is hyperlactatemia. CASE PRESENTATION: The case is of a 16-year-old female of North African ethnicity with history of poorly controlled type I diabetes who was brought to the emergency department for dyspnea and tachycardia, treated initially for diabetic ketoacidosis. Her persistent hyperlactatemia helped to reveal a more subtle condition known as Mauriac syndrome after multiple examinations and follow-up. CONCLUSIONS: This case reports shows that Mauriac syndrome is a rare condition that should be considered in a setting of poorly controlled type I diabetes, hepatomegaly, Cushingoid appearance, and hyperlactatemia. The current treatment of this condition is a strict control of blood glucose levels with an attempt to achieve an acceptable glycated hemoglobin value.