Nitrites (amyl, butyl, isobutyl, isopropyl) exposure may be accidental or intentional. It can range from a mild to life-threatening condition depending on the patient and the dose absorbed.
Possible routes of exposure:
(1) inhalation
(2) ingestion
(3) transdermal
Inhalation:
(1) treat of angina
(2) inhalation abuse ("poppers", "snappers")
(3) industrial (dyes, fabrics, linens, other industries)
Ingestion:
(1) cured meats
(2) spinach or other vegetables rich in nitrates, converted to nitrites by bacteria
(3) ingestion of room deodorant solution
Signs and symptoms:
(1) nausea and vomiting
(2) cyanosis (related to methemoglobinemia)
(3) headache
(4) dizziness
(5) weakness
(6) loss of consciousness
(7) skin irritation around nose and lips if inhaled
(8) peripheral vasodilation with hypotension
(9) feeling of intoxication
(10) bradycardia
(11) tachypnea and dyspnea
(12) blurred vision
(13) seizures
(14) abdominal pain and diarrhea
Laboratory findings:
(1) chocolate-brown blood (due to methemoglobinemia)
(2) elevated methemoglobin in blood
An oral dose > 0.4 mg/kg body weight may be fatal.
