Staïkowsky F, Perret A, Péviriéri F, Zanker C, Zerkak D, Pelloux P, Danhiez F
Service des Urgences, Hôpital Rothschild, Paris.
Presse Med. 1997 Oct 4;26(29):1381-4.
Methemoglobulinemia 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.
Four 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.
Poppers 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.
高铁血红蛋白血症应作为发绀患者的鉴别诊断之一。最近在法国，因吸入亚硝酸异戊酯导致的获得性高铁血红蛋白血症病例有所增加。
四名患者在昏迷且伴有发绀的状态下被送入巴黎一家医院的急诊室。所有四名患者在入院前不久都吸入了亚硝酸异戊酯。3例患者在静脉输注亚甲蓝后临床过程迅速好转。
亚硝酸异戊酯是无机脂肪族亚硝酸盐，因其对平滑肌的松弛作用和催情作用而被使用。一个鲜为人知的作用是会引发高铁血红蛋白血症。由于高铁血红蛋白无法结合氧气，导致组织缺氧，进而使血液呈现棕色或蓝色。高铁血红蛋白通常源于接触多种氧化化合物，包括某些药物。亚甲蓝是有症状的高铁血红蛋白血症的特效治疗药物。这四个病例强调了在性用品商店出售的产品的毒性作用，并提醒人们注意其中涉及的危及生命的风险。
