Methaemoglobinaemia due to mephedrone ('snow')

Acquired methaemoglobinaemia is a serious complication caused by many oxidising drugs. It presents as cyanosis unresponsive to oxygen therapy. The case of 33-year-old male patient who presented in our department after noticing blue lips and fingers is presented. He had sniffed 1 g of 'snow' after buying it from a head shop. His oxygen saturation by pulse oximeter on room air at presentation was 90%, which did not improve with supplemental oxygen. Arterial blood gas analyses showed partial pressure of oxygen 37 kPa while on supplemental oxygen and a methaemoglobin concentration greater than 25%. The patient denied using any other recreational drugs and was not on regular treatment. Therefore, a diagnosis of methaemoglobinaemia due to mephedrone, which is the active ingredient of 'snow', was made. Treatment is with intravenous methylene blue. Our patient started to improve so methylene blue was not used and he was discharged after 8 h.