Married ER Physicians Land in Hospital From Jungle Juice

This isn’t the “jungle juice” mixture of alcohol that you can find in the basement of a fraternity house on a Friday night. Jungle Juice, otherwise known as “poppers,” is an inhalant that contains isobutyl nitrite which quickly creates feelings of euphoria — and no, it is not legal for sale in the United States. When two married emergency room doctors got their hands on the stuff, things transpired when they used the product in the wrong way.

A team from the division of Pulmonary, Critical Care & Sleep Medicine at New York University Langone Medical Center will present the case report will be described in a poster session at CHEST 2015 in Montréal, Canada.

It started when the husband, age 39, called emergency personnel because his wife, age 33, had a seizure. When medical services arrived on the scene, the husband said that he had difficulty breathing. The couple developed severe cyanosis, or when the skin appears blue from a lack of oxygen, and had lowering blood pressure. At the ER, both patients’ methemoglobin levels were over 20%, but they were so high that they couldn’t be properly measured. They also had lactic acidosis, or low pH levels, and very low oxyhemoglobin levels, an oxygen-loaded protein in red blood cells.

So what was going on here? Well, the patients revealed that they had each taken 15 mL of Jungle Juice. But there’s a problem here: the couple ingested the substance when it is meant to be inhaled. The patients were diagnosed with methemoglobinemia, “a condition in which oxidation of ferrous iron creates an altered state of hemoglobin that is unable to adequately unload oxygen, resulting in tissue hypoxia,” the investigators explained. In other words, it's a blood condition where too much hemoglobin (the protein in red blood cells that distributes oxygen in the body) is present and the oxygen is not properly released to body tissues.

The couple was given intravenous methylene blue and hydration, and within six hours, all of their symptoms had cleared.

Although rare, severe methemoglobinemia can occur from inhaling or ingesting isobutyl nitrite. Luckily, it appears that the condition can improve quickly with treatment of methylene blue.

Moral of the story? Just say 'no' to Jungle Juice.