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Isobutyl nitrite is one of the popular recreational drugs with high abuse potential that is known to cause methemoglobinemia. While inhaling this recreational drug, often referred to as a ‘popper’, is the typical route of administration, oral ingestion can produce a more rapid and fulminant course of methemoglobinemia. We present the case of a 69-y...
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Methemoglobinemia, defined as hemoglobin's impaired oxygen-carrying capacity due to oxidation from the ferrous (Fe2+) state to the ferric (Fe3+) state, has many well-documented etiologies. One example of an uncommon cause of acquired methemoglobinemia is the ingestion of nail polish remover, which can contain methemoglobin generators such as nitroe...
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... The toxicity of nitrates is due to their transformation into nitrites and nitroso compounds, in particular nitrosamines and nitrosamides (Brkid et al., 2017;Karwowska and Kononiuk, 2020). It is mainly related to the occurrence of methemoglobinemia, which results from the binding of the nitrites formed on haemoglobin and the oxidation of ferrous iron (Fe 2 + ) to ferric iron (Fe 3 + ), transforming haemoglobin into methaemoglobin, which impairs the transfer of oxygen to the body's tissues (Knobeloch et al., 2000;Mensinga et al., 2003;Taylor et al., 2021). The risk is higher in babies and infants because the pH in the stomach tends to be higher than that of an adult, allowing for an easier proliferation of bacteria with nitrate reductase activity, which is favourable to the conversion of ingested nitrates (in high concentrations) into nitrites. ...
Nitrates are chemical substances naturally present in the environment (plants, soil, water) and are involved in the natural nitrogen cycle. They represent the most stable oxidation state and are essential nutrients for plant growth. The exposure and ingestion of nitrates by the population are mainly through the consumption of vegetables and occasionally through water intake. The objective of this study is to determine the nitrate content of various varieties of vegetables from industrial agriculture consumed by the population in three cities in northern Morocco's Rabat-Salé-Kenitra region, as well as to demonstrate the health risk of consuming a high concentration of nitrate. The results determine the nitrate content of 77 vegetable samples harvested in Morocco's Rabat-Salé-Kenitra region. The results showed that nitrate concentrations in vegetables varied depending on different areas in the city and whether the sample was organic or non-organic. The results of our study vary from 31.4 mg/kg (red onion) to 7860 mg/kg (beetroot) in the different vegetable varieties studied. It is recommended that this level be monitored on a regular basis and that the population be made aware of the recommended daily consumption of nitrates (0.84 mg-N/kg/d or 3.7 mg NO3-/kg/d) in the region to prevent excessive exposure to these potentially toxic compounds. In addition, it is advised to promote sustainable agriculture techniques aimed at lowering overall nitrate levels in the food supply and boosting the health and sustainability of the area's food system.
... an emphasis on any oral or nasal skin findings and patient smell may help narrow the differential diagnosis. Patients that abuse nitrite-containing compounds may present with methemoglobinemia or polyneuropathy due to pathways not affected by hydrocarbons [12]. Vapors containing methanol can lead to vision loss [13]. ...
Ethyl chloride is a common topical anesthetic. However, when abused as an inhalant, effects can range from headaches and dizziness to debilitating neurotoxicity requiring intubation. While previous case reports describe the short-term reversible neurotoxicity of ethyl chloride, ours show chronic morbidity and mortality outcome. During the initial evaluation, it is essential to consider the rising trend of commercially available inhalants being used as recreational drugs. We present a case of a middle-aged man presenting with subacute neurotoxicity due to repeated abuse of ethyl chloride.
... There are many well-documented congenital and acquired etiologies of MH. While uncommon, cases of MH have been reported from ingestion of nail polish remover and artificial nail remover solutions containing methemoglobin (MetHb) inducers such as nitroethane, N,N-dimethyl-p-toluidine, and isobutyl nitrite [2][3][4]. Other potentially toxic substances found in these solutions include acetone, toluene, methanol, ethyl acetate, methyl ethyl ketone, and butyrolactone, as well as dyes, oils, and scents that may irritate or corrode the mucosal lining [2]. ...
... There are numerous well-documented acquired MH etiologies, with dapsone and benzocaine being the most commonly used agents. Other acquired causes include exposure to herbicides, pesticides, exhaust fumes, industrial chemicals, and many pharmaceuticals (chloroquine, metoclopramide, nitroglycerin, and sulfonamides to name a few) [3]. One less common cause of acquired MH is ingesting certain nail polish remover and artificial nail remover solvents. ...
... Inhalation of this recreational substance induces vasodilation and a state of euphoria followed by reflex tachycardia, which, in combination, can create feelings of enhanced sexual pleasure. When ingested, isobutyl nitrite, with its substantial oxidizing properties, induces a more fulminant course of symptoms and can progress to MH [3]. Nitroethane is occasionally used as a solvent in nail polish removers and is more commonly used in artificial nail removers. ...
Methemoglobinemia, defined as hemoglobin's impaired oxygen-carrying capacity due to oxidation from the ferrous (Fe2+) state to the ferric (Fe3+) state, has many well-documented etiologies. One example of an uncommon cause of acquired methemoglobinemia is the ingestion of nail polish remover, which can contain methemoglobin generators such as nitroethane, N,N-dimethyl-p-toluidine, and isobutyl nitrite. We present a case of methemoglobinemia in an 81-year-old male following accidental ingestion of isobutyl nitrite-containing nail polish remover, commonly used as a recreational inhalant. Furthermore, we review potentially toxic substances found in commercially available nail products. This case was designed to identify and efficiently treat a rather uncommon cause of methemoglobinemia induced in this case by a common household item, nail polish remover.
An illite-montmorillonite clay from Naima, IMN (Algeria) was treated via physical and chemical treatment (TIMN) and investigated for the removal of methylene blue. IMN and TIMN clays were characterized by XRD, XRF, SEM-EDS, DSC-GA, FTIR and DC electrical conductivity methods. To analyze the sorption behavior of MB on the clays, a mechanistic model for interpreting the sorption data was developed. IMN clay revealed high sorption capacity (1.925 × 10−2 kg kg−1) for MB in 60 min. The pseudo-second-order model had a very good agreement to describe the MB adsorption process. The adsorption capacities, qe,exp, of 4.327 × 10−2 and 4.914 × 10−2 kg kg−1 for IMN and TIMN, respectively, were obtained. The free energy from the D–R model from adsorbing MB using IMN and TIMN ranged from 1.581 to 0.745 × 10−3J mol−1, respectively, suggesting that the process is physisorption. Besides, the sorption process was more sensible to temperatures that increase was beyond 40 °C causing a decrease in adsorption capacity, indicating that the adsorption reaction of MB onto IMN was exothermic. The adsorption mechanism of I/M clay to remove MB was likely based on hydrogen bonding, electrostatic attraction, cation exchange and n–π interaction. These results proved that TIMN was a promising adsorbent for removing MB from its simulated wastewater.
Unintentional exposure to nitrite- or nitrate-containing toxic salts is a recognized cause of acquired methemoglobinemia (MetHb). This systemic alteration of the blood can be fatal if not recognized and treated promptly. The intentional ingestion of sodium nitrite (NaNO 2) or sodium nitrate (NaNO 3), causing MetHb, is an uncommon and recently identified method of suicide, with the first reported case in the literature occurring in New Zealand in 2010. In this case series we present 28 cases of sudden death of individuals with evidence of MetHb and/or toxic salt ingestion, occurring in the Province of Ontario, Canada, between the years 1980 and 2020, inclusive. Of the 28 deaths in our case series, 25 showed evidence of intentional ingestion of sodium nitrite or sodium nitrate salts. Our year-over-year data demonstrated this is an increasingly used method of suicide in our provincial population, with the majority of cases occurring in the final two years of our study.
Postmortem detection of MetHb is typically established via screening techniques such as scene evidence suggesting fatal consumption of a toxic salt in addition to the characteristic grey-purple lividity observed upon the body. The diagnosis can be established via postmortem blood testing demonstrating elevated methemoglobin saturation. Additionally, we have confirmed that postmortem MRI in cases of MetHb demonstrates a T1-bright (hyperintense) signal of the blood; both within intracardiac blood on chest MRIs and postmortem blood samples in tubes.
