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Ventricular fibrillation in a 21-year-old after inhalation of an isobutyl nitrite "popper" product. Am J Emerg Med 2023 Feb;64:204.e5-204.e7

Date

11/12/2022

Pubmed ID

36369048

DOI

10.1016/j.ajem.2022.10.048

Scopus ID

2-s2.0-85141488454 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

BACKGROUND: Alkyl nitrite analogs known as "poppers" have been inhaled recreationally for decades. They are available to be purchased from gas stations marketed as "nail polish remover not for human consumption". These rapid-onset, short-acting, vasodilators cause the user to experience euphoria, dizziness, tachycardia and flushing. While chronic use may lead to problems such as methemoglobinemia or neuropathy, nitrites rarely lead to acute life-threatening side effects such as ventricular dysrhythmias.

CASE REPORT: We report a case of ventricular fibrillation cardiac arrest in a 21-year-old male after inhaling from a solution labeled to contain isobutyl nitrite, a rarely reported adverse effect of "popper" use. The product was analytically confirmed to contain mainly isobutyl alcohol, volatile hydrocarbons, and isobutyl nitrite, as well as smaller quantities of other substances. The patient was also prescribed escitalopram and hydroxyzine may have contributed. Return of spontaneous circulation was achieved in the field after initiation of CPR and defibrillation. He was found to have no clear predisposition to arrythmias during his care or on follow up.

CONCLUSION: Alkyl nitrite "popper" users and clinicians should be aware that products labeled to contain nitrites may contain volatile hydrocarbons along with nitrites and have the potential to cause arrhythmia.

Author List

Gooley B, Lofy T, Gross J, Sonnenberg T, Feldman R

Authors

Ryan J. Feldman PharmD Adjunct Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin
Taylor Sonnenberg MD, MSGH Assistant Professor in the Emergency Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Arrhythmias, Cardiac
Humans
Male
Nitrites
Ventricular Fibrillation
Young Adult