• Brian Gooley, Thomas Lofy, Joshua Gross, Taylor Sonnenberg, and Ryan Feldman.
• The Medical College of Wisconsin, Department of Emergency Medicine, Division of Medical Toxicology, 9200 W Wisconsin Ave, Milwaukee, WI 53226, United States of America. Electronic address: bgooley@mcw.edu.
• Am J Emerg Med. 2022 Nov 3.

BackgroundAlkyl nitrite analogs known as "poppers" have been inhaled recreationally for decades. They are available to be purchased from gas stations marketed as "nail polish remover not for human consumption". These rapid-onset, short-acting, vasodilators cause the user to experience euphoria, dizziness, tachycardia and flushing. While chronic use may lead to problems such as methemoglobinemia or neuropathy, nitrites rarely lead to acute life-threatening side effects such as ventricular dysrhythmias.Case ReportWe report a case of ventricular fibrillation cardiac arrest in a 21-year-old male after inhaling from a solution labeled to contain isobutyl nitrite, a rarely reported adverse effect of "popper" use. The product was analytically confirmed to contain mainly isobutyl alcohol, volatile hydrocarbons, and isobutyl nitrite, as well as smaller quantities of other substances. The patient was also prescribed escitalopram and hydroxyzine may have contributed. Return of spontaneous circulation was achieved in the field after initiation of CPR and defibrillation. He was found to have no clear predisposition to arrythmias during his care or on follow up.ConclusionAlkyl nitrite "popper" users and clinicians should be aware that products labeled to contain nitrites may contain volatile hydrocarbons along with nitrites and have the potential to cause arrhythmia.Copyright © 2022. Published by Elsevier Inc.

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