Severe Methemoglobinemia Following Alkyl Nitrite Ingestion: A Case Report

We report a case of a 40-year-old male who presented to the emergency department with central cyanosis, altered mental status, and hypoxia that was refractory to supplemental oxygen following ingestion of an alkyl nitrite product called "Liquid Gold". Arterial blood gas and co-oximetry confirmed a diagnosis of severe methemoglobinemia with a methemoglobin (MetHb) level in excess of 30%. The patient was treated with intravenous methylene blue and responded quickly both clinically and biochemically. This case further highlights the need to consider the dangers of recreational nitrite toxicity, the pitfalls of standard pulse oximetry in the setting of dyshemoglobinemia, and the value of prompt antidote therapy when faced with toxicological cases.