"Found down in a car"
Temp 109.5F, HR 155, BP 128/75, RR 35, POx 93%RA
- What other information?
- What tests?
- What interventions?
Amyl Nitrite ("Poppers")
- Nitrites cause brief (less than 5 minutes) periods of intense vasodilation
- Sensation of warmth, hypotension, reflex tachycardia, prolonged penile erection, anal sphincter relaxation
- May also lead to headache, nausea, syncope
- Methemoglobinemia more common with oral rather than inhaled forms
- Oxidation of Fe2+ to Fe3+
- Oxidized heme molecule less able to deliver oxygen to tissue
- Symptoms - headache, dyspnea, syncope, palpitations, altered mental status
- Signs - discolored skin, "chocolate" colored blood, cyanosis, acidosis
- Congenital - G6PD, erythrocyte methemoglobin reductase, pyruvate kinase
- Medications - Amyl nitrite ("poppers"), pyridium, local anesthetics, sulfonamides
- Methylene blue 1% IV solution 1-2 mg/kg over 3-5 minutes
- Repeat dose 1 mg/kg @ 30 minutes
- Exchange transfusion - G6PD-deficient individuals
- Hyperbaric oxygen treatment – if methylene blue fails
- IVF / bicarbonate - for metabolic acidosis