Lessons of the month 3: Intravenous poppers abuse: case report, management and possible complications

Abstract

Background: Poppers are nitrite-containing liquids, which are inhaled for their aphrodisiac and hallucinogenic effects. Despite some cases of severe poisonings, poppers are often perceived as harmless by consumers. Inhalation and ingestion of poppers are well known, but, according to our literature review, intravenous abuse has not been reported before.

Case presentation: A 34-year-old man injected poppers intravenously for recreational purposes. He then suffered from dyspnoea and general discomfort. Upon arrival of emergency medical services, the patient was dyspnoeic with blue-grey skin colour and oxygen saturation was 82% on ambient air. Non-invasive ventilation was necessary, and he was transferred to the intensive care unit. Toluidine blue was administered because of a methaemoglobinaemia of 40% and methaemoglobin levels dropped to 0.4%. He was discharged home after a 24-hour observation. We additionally analysed the contents of the poppers bottle: isopropyl nitrite, isopropanol and acetone were detected. Possible complications and the treatment regarding intravenous administration of poppers are discussed.

Conclusion: We present the first published case of intravenous poppers abuse. Our patient suffered from methaemoglobinaemia and was rapidly discharged after treatment with toluidine blue. No specific treatment regarding the contents of the poppers bottle, apart from isopropyl nitrite, was necessary.

Keywords: Poppers; drug abuse; methaemoglobinaemia; nitrites.

Fig 1.

Photograph of the front of the poppers bottle ‘boooster’. The content ‘isopropyl nitrite’ indicated on the bottle has been marked in red.

Fig 2.

Headspace gas chromatography with flame ionisation detection analysis of the ‘boooster’ contents. The left-most and highest peak is isopropyl nitrite, the middle peak is isopropanol and the right peak is acetone.