Severe Methemoglobinemia Due to Accidental Ingestion of Nitrite-Containing Nail Polish Remover: A Case Report

Background:Methemoglobinemia is an uncommon hemoglobinopathy caused by oxidation of heme iron from its ferrous (Fe 2+ ) state to the ferric (Fe 3+ ) state, resulting in functional anemia that does not improve with supplemental oxygen."Poppers" is a slang term for recreational drugs marketed as nail polish removers or room deodorizers, often sold under brand names such as "Jungle Juice," which may cause methemoglobinemia due to their nitrite content. Case Report:A 67-year-old White woman accidentally ingested "Jungle Juice" nail polish remover containing isobutyl nitrite, resulting in severe methemoglobinemia.Clinical hallmarks included cyanosis, chocolate-colored blood, refractory hypoxemia unresponsive to supplemental oxygen, and a partial pressure of oxygen (PaO 2 )-saturation gap. Conclusions:Methemoglobinemia is a potentially life-threatening hemoglobinopathy that causes functional anemia unresponsive to supplemental oxygen."Poppers" can induce methemoglobinemia.Despite legislative efforts to regulate these products and prevent misuse, manufacturers continue to exploit regulatory loopholes by producing chemical analogs exempt from current drug laws.Additionally, there has been an emerging trend of sodium nitrite ingestion to induce methemoglobinemia in suicide attempts over recent years, driven by its accessibility and increasing online dissemination.Given the rise in "popper" use and sodium nitrite ingestion, emergency physicians should be aware of these trends and the associated products to facilitate early recognition and prompt treatment of this rare condition.