Methemoglobinemia in the Setting of Consumption of Poppers and Preservation Pellets

Methemoglobinemia can be either an acquired or congenital condition in which the state of the iron atom is altered pathologically, and it cannot adequately deliver oxygen molecules to peripheral tissues. This may be due to drug or environmental exposures, such as antibiotics and local anesthetics, or patients may have a congenital defect in specific hemoglobin proteins or enzymes. We present a patient who presented with peripheral cyanosis and respiratory distress without a clear initial cause. It was later identified that the patient had swallowed an entire bottle of 'poppers' with preservation pellets, which led to an acute state of methemoglobinemia. The patient was treated with methylene blue and placed on observation for airway management. With many recreational sources of potential causes of methemoglobinemia, including over-the-counter drugs and even vegetables, clinicians must take a thorough history to look for the root cause of the presenting symptomatology.