A man in his 60s with no relevant previous medical history presented to an urban, major trauma centre by ambulance after being found with a head injury in a nightclub. The paramedics reported he was hypoxic, hypotensive and tachycardic with altered mental status. At the emergency department, he had oxygen saturations of 85% despite high-flow oxygen and was hypotensive at 88/43mmHg. We were concerned the patient was haemorrhaging given the lack of response to oxygen therapy and their hypotension. However, an arterial blood gas (ABG) established a diagnosis of methemoglobinaemia. Methylthioninium chloride was promptly administered, and the patient’s condition improved. He later reported using recreational drugs, including alkyl nitrites (‘poppers’). He was monitored until his fraction of methaemoglobin returned to normal baseline levels with serial ABGs. He was discharged 24 hours later. It was suspected that his use of alkyl nitrites was the most likely cause of methaemoglobinaemia.
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Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: KE contributed to the working, editing, researching of content and referencing. SS was the supervising consultant and contributed to the working and researching of content. GM was the main author who contributed to all stages of the work: planning, writing, editing and submission process.The following authors gave final approval of the manuscript: GM.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.