Department of Emergency Medicine

UMEM Educational Pearls

Category: Toxicology

Title: Toxicological etiology of patient with flushed skin .

Keywords: flushed skin (PubMed Search)

Posted: 9/16/2015 by Hong Kim, MD, MPH (Updated: 5/28/2023)
Click here to contact Hong Kim, MD, MPH

 

Monosodium glutamate

  • Rapid onset 30 min and lasts about 1 hour
  • May accompanied with headache & chest pain.
  • No associated GI sx.
  • History of eating Chinese fodd. AKA "Chinese restaurant syndrome"

 

Metabisulfites (Na sulfite, Na/K bisfulfite, Na/K metabisulfite, etc.)

  • Food preservatives found in dried fruit, wine, molasses, sauerkraut, etc.
  • Bronchospasm – asthma like, headache, mild hypotension can occur
  • Most significant reaction in people with asthma/allergies
  • History of trying to eat "healthy"

 

Tyramine reaction

  • Mostly among patients taking MAO inhibitors
  • Source of tyramine (food): fermented, pickled product, avocado, chocolate, etc.

 

Niacin

  • Burning warm sensation to body
  • Often used for sexual enhancement, elevated cholesterol and beating drug urine screens

 

Trichloroethylene

  • Occupational exposure – AKA “Degreaser’s flush”
  • Facial flushing, head pressure, lacrimation & blurred vision may occur
  • Require several weeks of exposure prior to symptoms

 

Scrombroids

  • Occurs after a “fish meal” (e.g. dark meat fish - tuna)
  • Associated with GI symptoms (nausea, vomiting, diarrhea)
  • Histamine related reaction due to poor refrigeration after catching fish.

 

Hydroxocobalamin

  • Antidote for CN poisoning
  • Skin become red after administration due to its color (red)

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