Acquired methemoglobinemia is rare, however it could be fatal. Symptoms such as headache, fatigue, dyspnea, and syncope occur as methemoglobin levels rise, while levels above 50% can precipitate seizures, arrhythmias, coma, and even death. We are presenting a case where a middle-aged male ingested an energy drink named as “PWED super rush "for recreational purposes. Upon checking, it was noted that this drink contains isobutyl nitrite as the main ingredient that enhances sexual experience due to its vasodilatory properties.  A 52-year-old male with past medical history of hypertension, hyperlipidemia, asthma, and alcohol use disorder presented via EMS with acute onset of lightheadedness, a near-syncopal episode shortly after drinking an energy drink followed by nausea and vomiting.  Vital signs in the ER showed significant hypoxia and otherwise unremarkable. CXR showed no findings concerning fluid overload or community acquired pneumonia. He tested negative for covid. The patient was started on nonrebreather, however, SpO2 remained in 84-88% with supplemental oxygen. To find out the cause of unexplained refractory hypoxia, blood gas analysis was obtained that showed pH of 7.357, pCO2 44, pO2 64, with methemoglobin 25.2%. Based on ABGs results and the initiation of sequence of events following ingestion of an energy drink, toxicology was consulted, and patient was started on methylene blue. He was admitted to ICU for close monitoring and after two doses of methylene blue 1mg/kg, his clinical symptoms significantly improved, successfully transitioned to nasal cannula. Repeat ABGs afterwards showed improvement in methemoglobin levels to 1.0%. His hospital course was uncomplicated, and he was discharged home in stable condition after counseling on substance use.  Methemoglobinemia is treated with hyperbaric oxygen, methylene blue, ascorbic acid, riboflavin in high doses and exchange transfusion in refractory cases. The first line treatment-Methylene blue acts via the NADPH reductase pathway to regenerate ferrous heme and reduce further oxidation. This case emphasizes the need for a high index of suspicion for methemoglobinemia in cases of refractory hypoxia, especially in the setting of possible toxic ingestion. Point-of-care co-oximetry can quickly diagnose elevated methemoglobin levels when unavailable on ABG analysis.  Additionally, enhanced public awareness and restricting access to agents like isobutyl nitrite are needed to prevent further recreational cases that can overburden emergency departments, intensive care units, and hospitals.