Seizures and severe methaemoglobinaemia following accidental ingestion of amyl nitrite.

We present a case of a man in his late 40s presenting with generalised tonic-clonic seizures and profound methaemoglobinaemia shortly after inadvertent ingestion of amyl nitrite. Arterial blood gas analysis demonstrated methaemoglobin levels exceeding the upper detection threshold of our analyser, accompanied with profound cyanosis despite apparent oxygen saturations of 94%. Prompt administration of intravenous methylene blue led to a rapid and complete recovery. This case highlights the importance of swift recognition and treatment of methaemoglobinaemia particularly when the precipitating factor may be unknown at the time of presentation. This case also demonstrates the potential limitations of bedside blood gas analysers in diagnosis.

Nitrite inhalants use and HIV infection among men who have sex with men in China.

OBJECTIVE: This is the first study in China to examine the use of nitrite inhalants and its correlates among men who have sex with men (MSM) in Beijing, China. METHODS: A cross-sectional survey was conducted in 2012. Structured interviews collected data on demographics, sexual and drug use behaviors, and the use of HIV services. Blood specimens were collected and tested for HIV and syphilis. RESULTS: A total of 400 MSM eligible for the study were between 19 and 63 years of age and overall HIV prevalence was 6.0% (9.0% among nitrite inhalant users and 3.3% among nonusers). Nearly half (47.3%) of them reported ever using nitrite inhalants and 42.3% admitted using nitrite inhalants in the past year. Multivariable logistic analysis revealed that ever using nitrite inhalants in the past was independently associated with being aged ≤25 years, having higher education attainment, seeking sex via Internet, having casual partners in the past three months, and being HIV positive. CONCLUSION: The use of nitrite inhalants was alarmingly prevalent among MSM in Beijing. The independent association of the nitrite inhalant use with more casual sex partners and HIV infection underscored the need for intervention and prevention of nitrite inhalant use.

Near-fatal methemoglobinemia after recreational inhalation of amyl nitrite aerosolized with a compressed gas blower.

Adverse effects associated with recreational inhalation of nitrites are usually mild and rarely life-threatening. We report a rare case of near-fatal methemoglobinemia after inhalation of amyl nitrite after aerosolizing the liquid using a compressed gas blower designed to clean photographic equipment that employed hydrofluoroalkane-134a as a propellant. A 31-year-old previously healthy male became dyspneic and fainted soon after the recreational inhalation of amyl nitrite aerosolized using a compressed gas blower. He was brought to the emergency department with severe cyanotic appearance and profound shock. Oxygen saturation was 82%, unresponsive to oxygen supply. His methemoglobin blood level was 52.2%. After 100 mg of methylene blue (2 mg/kg body weight) was administered intravenously, he recovered consciousness, and dyspnea and cyanosis subsided gradually. This case illustrates the extraordinary hazard of the use of a compressed gas blower in the recreational inhalation of nitrites. Prompt recognition and rapid antidotal treatment may adequately correct near-fatal overdose associated with recreational use of amyl nitrite.

Irreversible blindness after amyl nitrite inhalation.

PURPOSE: To present a case of blinding bilateral acute optic nerve disease in a 15-year-old male apparently induced by inhalation of amyl nitrite. METHODS: Sequentially over four days he lost his four altitudinal visual hemifields, leaving atrophic discs and only 2/60 and a small field in the better eye. Scannings by CT and MRI and a full laboratory research gave no specific clue to the pathogenesis. CONCLUSIONS: No similar cases have been described in the more than 100-year history of pharmacological use of amyl nitrite for angina pectoris, and pharmacologically it is hard to point out a rationale behind the sequential visual loss As an alternative to frank toxicity, therefore, we have considered a parainfectious mechanism as related to an influenza-like disease immediately prior to the abuse episode.

[Amyl nitrite poisoning]. / Amylnitritforgiftning.

Two cases of amylnitrite poisoning are presented. In both cases, severe methaemoglobinemia developed after ingestion of approximately 10 ml of amylnitrite. When admitted to hospital, both patients were deeply cyanosed, and arterial blood samples were noticed to be chocolate brown. They were intravenously treated with methylene blue. Within one hour the condition of both patients had improved dramatically, and blood gas-samples had normalised. In cases of cyanosis with no obvious genesis, poisoning with amylnitrite should be considered.

Saturday night blue--a case of near fatal poisoning from the abuse of amyl nitrite.

A case of severe methaemoglobinaemia caused by the abuse of volatile nitrites is reported. The agents are commonly abused, but this complication is rare. The clinical presentation can make diagnosis difficult; however, the subsequent treatment needs to be rapid to avoid serious morbidity or mortality. This report presents the clinical picture and the background information leading to the detection and treatment of this unusual problem.

Methaemoglobinaemia presenting with status epilepticus.

A case is reported of methaemoglobinaemia presenting with recurrent fits in the absence of cyanosis. A low oxygen saturation measured on pulse oximetry that fails to improve with oxygen treatment, the presence of "chocolate brown" blood that does not change on exposure to air, and a high PaO2 arterial blood gas with oxygen therapy should support such a diagnosis. A diagnostic blood methaemoglobin level should be obtained.

Amyl nitrite related deaths.

Two cases of death associated with amyl nitrite are discussed. An attempt is made to highlight its noxious properties and the difficulty in attributing death to it when inhaled.

Methaemoglobinaemia after ingestion of amyl nitrite.

We report a case of methaemoglobinaemia in a 2 year old girl after ingestion of an 'aphrodisiac' containing nitrite. The availability of these products, their poor labelling, and their intended presence in domestic bedrooms all serve to increase the hazard they pose to young children.