"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

Methemoglobinemia

• 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

Causes

• Congenital - G6PD, erythrocyte methemoglobin reductase, pyruvate kinase
• Medications - Amyl nitrite ("poppers"), pyridium, local anesthetics, sulfonamides

Treatment

• Oxygen
• 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