• F Staïkowsky, A Perret, F Péviriéri, C Zanker, D Zerkak, P Pelloux, and F Danhiez.
• Service des Urgences, Hôpital Rothschild, Paris.
• Presse Med. 1997 Oct 4;26(29):1381-4.

BackgroundMethemoglobulinemia should be entertained as a differential diagnosis in patients with cyanosis. Recently in France there has been an increase in the number of cases of acquired methemoglobulinemia due to inhalation of poppers.Case ReportsFour patients were admitted to the emergency room of a Paris hospital in a state of unconsciousness with cyanosis. All four patients had inhaled poppers shortly before admission. The clinical course was rapidly favorable after intravenous infusion of methylene blue in 3 cases.DiscussionPoppers are inorganic aliphatic nitrites used for their relaxing effect on smooth muscle and for their aphrodisiac effect. One poorly recognized effect is the development of methemoglobulinemia. Tissue hypoxia results because methemoglobulin cannot bind oxygen, leading to a brown or blue coloration of the blood. Methemoglobulin usually results from exposure to a wide variety of oxidizing compounds including certain drugs. Methylene blue is the specific treatment for symptomatic methemoglobulinemia. These four cases emphasize the toxic effect of products sold in sex shops and calls attention to the life-threatening risks involved.

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