Methaemoglobinemia Induced by Poppers and Bupropion Intoxication in the Emergency Department

Authors

• Frederico Batista Medicina IV, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
• Carlos Alves Pneumologia, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
• Miguel Trindade Medicina IV, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
• Joana Azevedo Duarte Medicina IV, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
• Ricardo Marques Medicina IV, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal

batista.frederico@gmail.com

Keywords

Abstract

A 40-year-old man presented to the emergency department with dyspnoea and fatigue after bupropion and popper consumption. Clinical examination was remarkable for central cyanosis not responding to supplementary oxygen. Arterial blood gas analysis showed a methaemoglobin value of 30.3%. Methaemoglobinemia was diagnosed and the patient was treated with methylene blue. However, during methylene blue administration, the patient developed a generalized tonic-clonic seizure that was successfully managed with diazepam. Combined intoxications can be a critical problem in the emergency department. Early recognition and treatment of poisoning are key for good patient outcome.