![]() However, methylene blue itself can cause methemoglobinemia when given in excess, and if the person also takes SSRIs, SNRIs, or MAOIs it can precipitate serotonin syndrome by reversibly inhibiting monoamine oxidase A. Give methylene blue, but don’t overdo it. Methylene blue donates electrons to the NADPH pathway (a minor one for reducing Fe3+ to Fe2+), and allows conversion of methemoglobin back to hemoglobin.Our patient’s actual arterial O2 content was 155 on non-rebreather face mask. MetHb absorbs equally at the red and infrared wavelengths used by traditional pulse oximetry, which results in an erroneous SpO2 readout near 85%. Don't believe your pulse oximeter: The probe functions by using 2 wavelengths of light (red and infrared) to measure the ratio between oxyhemoglobin and deoxyhemoglobin. ![]() ![]() Sodium nitrite which is in the similar family as amyl nitrite is sometimes used as an antidote for cyanide poisoning (generates methemoglobin which then binds cyanide) though hydroxocobalamin has now become the preferred treatment.Hence in our case the ashen appearance of the gentleman's skin. ![]() Methemoglobin shifts the oxygen desaturation curve to the left, meaning that O2 has a harder time dissociating to get to the tissues leading to poor tissue perfusion. More concerning, amyl nitrite is one of a list of drugs that cause oxidative stress on red blood cells: among other things, large amounts of this stuff can cause the oxidation of Fe2+ (normal hemoglobin) to Fe3+ (methemoglobin). It can also be snorted on its own to act as an aphrodisiac (known, apparently, as “poppers”). Other less pleasant physical effects include headache, flushing, tachycardia, a warming sensation, relaxation of involuntary muscle and dizziness. You can mix it into your cocaine to add on an extra duration of your high or increase tactile sensation. ![]() Typical positive sensations of amyl nitrite ingestion (usually via inhalation) include excitement and euphoria. However it also carries with it psychoactive properties which have led to its recreational use and high abuse potential. Amyl nitrite is part of the alkyl nitrite family and has been used previously in medicine for its vasodilator properties given that it can act as a source of nitric oxide. ![]()
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