November 1, 2025
“Rush” is the brand name of product that contains the active ingredients of alkyl nitrites, with the most common ingredient being isobutyl nitrite. As the name of the product implies, ingestion or inhalation of these alkyl nitrites may result in euphoria and muscle relaxing effects. They are also known as “poppers” given that the original amyl nitrite was available as a cloth covered glass vials known as “pearls” and would make a “popping” sound when crushed to release the vapors. These products are sold online and in adult novelty stores. Many of these products are disguised with labels that suggest these products are nail polish remover or room deodorizers. They are sold in bottles that are very similar to caffeine energy drinks.
The muscle relaxing effects can result in profound hypotension. In addition, nitrites are known to cause methemoglobinemia. Presentations of methemoglobinemia include cyanosis that does not improve with supplemental oxygen. Pulse oximeter readings typically remain in the mid 80% range. Samples of blood may have a “chocolate” appearance to it. Despite the cyanosis an arterial blood gas analysis will demonstrate a normal partial pressure of oxygen. Diagnosis of methemoglobin levels can be confirmed by measuring the methemoglobin level by co-oximeter of an ABG or VBG sample. There are case reports of severe, life threatening methemoglobinemia after exposure to alkyl nitrites.1, 2, 3 Treatment for the methemoglobinemia is intravenous methylene blue. However, in patients who have a history of G6PD deficiency, methylene blue can cause hemolysis so alternative therapies like blood transfusion may be needed.
The Food and Drug Administration has published an advisory against use of these products.3
Big shout out to Dr. Kristen Detorre, faculty in Department of Emergency Medicine at VUMC, for her astute diagnosis and outstanding management of one of these cases and alerting the Tennessee Poison Center!
Saralyn R. Williams, MD, Professor of Emergency Medicine, Medicine, and Pediatrics
- Stambach T, Haire K, Soni N, Booth J. Saturday night blue-a case of near fatal poisoning from the abuse of amyl nitrite. J Accid Emerg Med 1997;14:339-40.
- Edwards RJ, Ujma J. Extreme methaemoglobinaemia secondary to recreational use of amyl nitrite. J Acc Emerg Med 1995;12:138-42.
- Valenzuela M, Phan T, Samones E, Dukes WS. Do not drink poppers: A case report of near fatal methemoglobinemia after ingestion of alkyl nitrite. Cureus 2025 17; e77190. 4. https://www.fda.gov/food/alerts-advisories-safety-information/fda-advis…
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