Sodium nitrite poisoning cases The fire department found burned couches in the house with melted plastic covering. (2020) reported fourteen cases with nitrate concentration in peripheral blood between 68 microg/ml and 475 microg/ml (average Introduction: Sodium nitrite is an oxidizing agent capable of producing profound methemoglobinemia. In: Olson KR, ed. We The established method was successfully applied to 10 authentic sodium nitrite poisoning cases, resulting in low nitrite concentrations (32. Case Rep Emerg Med 2016;2016: 9013816. Sodium nitrite and sodium nitrate deaths by year of notification . Documented cases of sodium nitrite toxicity are almost exclusively caused by acciden-tal ingestion; however, self-poisoning with sodium nitrite represents an increasing trend in nitrate-related deaths [12,13]. 2023;1(5):1-3. Sodium nitrite causes methemoglobinemia, which eliminates cyanide from mitochondria in this application. It also proves that both costal cartilage and vitreous humor may serve as an alternative forensic The use of sodium nitrite in suicide has become more common among young adults in the Republic of Korea. A 17-year-old female reportedly drank approximately one tablespoon of sodium nitrite in a self-harm attempt. In Washington, we’ve helped 11 patients since 2022, six of whom experienced severe health effects or died. Sodium nitrite is the most prevalent drug for cyanide poisoning. Cyanide poisoning is traditionally treated with sodium thiocyanate. Background: Sodium nitrite is known to induce methemoglobinemia and hypotension when ingested, but reports of intentional ingestion remain rare. Vanderpyl MMJ. Sodium nitrite ingestion poses a considerable public health threat. Presented is a case of “iatrogenic” sodium nitrite poisoning that occurred during a medical examination and malabsorption test for three patients, resulting in the death of one of them. The results of the autopsy showed general signs of asphyxia, such as intense cyanosis of the extremities, brown-gray-blue-red livor mortis, and some Tardieu petechiae in Series of Clinical and Medical Case Reports and Reviews Case Report Citation: Arora V, Khatri A, Kumar G. Sodium nitrite is an inorganic compound usually seen as a crystalline powder that is very water soluble. It may not be the most common emergency case to present to prehospital clinicians, but cases of it do appear to be on the rise. Mudan et al. We present four cases of suicidal sodium nitrite ingestion that closely occurred within a two months-period. Sodium Determination of nitrite and nitrate in postmortem whole blood samples of 10 sodium nitrite poisoning cases: the importance of nitrate in determining nitrite poisoning. Table 2. Poisoning with these agents may be potentially life-threatening as a result of the production of methaemoglobin. Nitrates and nitrites. 111279, 10. Ten cases of fatal sodium nitrite ingestion were Of the ten deaths attributed to sodium nitrite toxicity, eight were male, and two were female. The value of nitrites as an antidote to cyanide poisoning is twofold: They oxidize hemoglobin to methemoglobin, which binds free cyanide, and they may enhance endothelial cyanide detoxification by producing Sodium nitrite overdose leads to profound methemoglobinemia and may quickly progress to death. Conclusions: Recent increases in azide poisoning This rise in sodium nitrite overdose cases indicates the need for a simple, quick test for suspected nitrite toxicity. In this study, a common Griess reagent color test (MQuant™ Nitrite Test Strips) was used as a presumptive method in cases where the ingestion of sodium nitrite was suspected. Autopsy investigations in these cases show We report a series of 15 cases, spanning an 18-month period, in which NaNO2 was the suspected cause of death. A few cases of accidental sodium nitrite intoxication are described [2], [13]. 3of4 saturation in the setting of methemoglobinemia. Side-effects Side-effects For sodium All 3 cases of intentional sodium nitrite ingestion resulted in the highest methemoglobin level exceeding 30. The results of the autopsy showed completely fixed grayish livor mortis, signs of asphyxia on the lips, and facial cyanosis. forsciint. He is somnolent but withdraws to pain. Four cups with a yellowish liquid and a scale for precise measurement were found at the scene. A. Europe PMC API case studies; SOAP web service; Annotations API; OAI service; Bulk downloads; Developers Forum; Help. This report details a cluster of sodium nitrite poisoning stemming from a dinner gathering on a maintenance ship. This paper reports three rare cases of accidental sodium nitrite poisoning, including one fatality, caused by the consumption of aspic purchased from a private vendor. 4 ± 18. Poison centers nationwide have treated an increasing number of teens and young adults who used concentrated sodium nitrite in suicide attempts. A blood test revealed a methemoglobin l The mechanism of death by sodium nitrite toxicity is severe hypoxia. [1] Mistaken ingestion of nitrites or excessive consumption of foods containing nitrites Table 1. 7 8 Toxicological data in rats showed a median lethal dose for 50% of participants after ingestion of 1270 mg In this case series of decedents in 2 New York medical examiner jurisdictions, sodium nitrite deaths increased yearly, and the medical examiners were able to obtain confirmatory nitrite concentrations in most cases. 412 Letters to the Editor Common drug-induced causes include benzocaine, phenazopyridine, and dapsone. Hickey had noticed these The established method was successfully applied to 10 authentic sodium nitrite poisoning cases, resulting in low nitrite concentrations (32. Navigating methemoglobinemia: a sodium nitrite poisoning case report and therapeutic considerations. This was tragically highlighted by the death of a 17 year old dental nurse after taking a single 1 g tablet of sodium In addition to suicide by barium salt poisoning, Hikin et al. So join us as we talk about methaemoglobinemia, safety on scene, protecting rescuers and the assessment and care of these pa Suicide by sodium nitrite poisoning is increasing. 4 SA 5 29. org. In the last decade, an increase in the number of suicides caused by SNP was observed. Upon arrival at the emergency department (ED), the patient was hypotensive, cyanotic, and cyanosis non-responsive to oxygen therapy. In this case repo fatal in severe cases. 3. The epidemiological investigation aims to uncover the in Recent literature indicates their potential use in treating cyanide poisoning [2]. A similar trend has recently been reported in the United The report also noted that in nearly all cases, sodium nitrite was the sole poison used, with victims often measuring out specific amounts to ensure a lethal dose. 5 6 Less is known, however, about sodium nitrate intoxication in humans, and only a few cases have been reported so far. Our medical toxicology service has encountered a similar series of patients in the past 12 months and wish to add our experience. The test results were consistent between specimens Background: Over the years, forensic pathology has registered the spread of new methods of suicide, such as the ingestion of sodium nitrite. One sodium nitrite case report noted that the suicide occurred four days after news reports covered a celebrity sodium nitrite ingestion suicide Two cases of fatal methemoglobinemia caused by self-poisoning with sodium nitrite: A case report. Question Are surveillance estimates of sodium nitrite suicide deaths consistent with cases confirmed by medical examiners?. An autopsy case of sodium nitrite-induced methemoglobinemia with various post-mortem analyses. Analysis of urine, gastric contents, liver and kidney, collected at the time of autopsy, confirm We report a case of a suicide survivor who presented with an intentional fatal overdose of sodium nitrite in an 18-year-old female by drinking approximately one tablespoon of sodium nitrite in a suicidal attempt. [52] The reported [53] signs of sodium nitrite poisoning are as follows: Symptoms of Case Series We report five cases of severe methemoglobinemia secondary to large sodium nitrite ingestion that were reported to and managed by the California Poison Control System in 2019 Sodium nitrite (SN, NaNO2) is a water-soluble, white-yellow crystalline powder with broad applications in food preservation, automotive maintenance, and animal control. Chemical analysis of food materials revealed the presence of sodium nitrite and potassium arsenate. 8 reported azide poisoning cases per year. , E250), widely used as preservative, antimicrobial agent by inhibiting effect of Clostridium botulinum, an anaerobic bacteria responsible for botulism, and by its capacity to fix the pink color of the cured meat and fish and some cheeses. We highlight the proper treatment of Case. Three were excluded in which the cause of death was ‘methaemoglobinaemia’ or ‘unascertained’. This rise in sodium nitrite overdose cases indicates the need for a simple, quick test for suspected nitrite toxicity. This included information about Request PDF | Sodium nitrite poisoning; A case series of 15 fatalities | Aim To highlight a recent surge in new drug deaths resulting from sodium nitrite (NaNO2) toxicity in which the post mortem Fatal sodium nitrite poisonings are unusual in the forensic setting. The oftentimes severe methemoglobinemia found in sodium nitrite poisoning cases results in systemic hypoxia, metabolic acidosis, and cyanosis. Field treatment for these patients includes airway management, vascular access, contacting poison control (1-800-222-1222) for guidance, and BLS/ACLS resuscitation as indicated Additionally, nitrite induces vasodilation and presents adverse side effects such as hypotension and syncope, restricting its use. Bearing all this in mind, sodium nitrite intoxication can easily go Sodium nitrite (NaNO2) is an inorganic compound that is commonly used as a preservative (E250) in the fish and meat industry. Severe methemoglobinemia due to sodium nitrite poisoning. Sodium nitrite is used mostly in the food industry (as a preservative) and in He was discharged after two nights total in the hospital for further psychiatric care. 6 g ; however, a case of a patient surviving after ingesting 6 g sodium nitrite has been reported . Sodium nitrite causes increased methemoglobin, resulting in systemic hypoxia, metabolic acidosis, Clinical manifestations can include cyanosis, hypoxia, altered consciousness, dysrhythmias, and death. 2021 Dec;59(12):1264-1269). The time between dinner and onset of illness was less than an a hour. It is a strong oxidizing agent that can oxidize hemoglobin iron (Fe) to its oxidized state, leading to methemoglobin formation. 4 ± Overview. The subsequent formation of methemoglobin (MetHb) restricts oxygen transport and utilization in the body, resulting in functional hypoxia at Since 2018, nearly 15 percent of nitrites and nitrates self-poisoning cases have resulted in death, with 88 percent of individuals requiring management in a health-care facility. 0 %), and the infant twins with nitrate poisoning. In order to reach a precise diagnosis of NaNO 2 intoxication, a complete toxicological analysis should be carried out including not only MetHb blood levels but also nitrites and nitrites in standard or alternative matrices as a routine Illicit drugs (amphetamine, cannabis and cocaine) were present in 3/20 cases (15%). Forensic Sci Med Pathol. Common adverse reactions include syncope, hypotension, tachycardia, methemoglobinemia, palpitations, dysrhythmia, methemoglobinemia, headache, dizziness, blurred vision. No cases of intentional sodium nitrite ingestion had been reported to the CPCS over the preceding 5-year period. Help using Europe PMC; Search syntax reference; Contact us; Methaemoglobinaemia may be caused by ingestion of a number of drugs, among them nitrites, some of which are remarkably toxic. Despite this delay in inducing a significant level of methemoglobinemia, reasonable protection offered by sodium nitrite can be This paper reports three rare cases of accidental sodium nitrite poisoning, including one fatality, caused by the consumption of aspic purchased from a private vendor. https://orcid. The University Hospitals of Leicester (UHL) NHS Trust post-mortem toxicology service receives samples from 27% of Her Majesty's Coroners in England and Wales, Case reports of sodium nitrite related suicide and suicide attempts (through February 2024) were identified in the medical and forensic literature. The remaining 16 cases had a history of ingesting Sodium nitrite poisoning can be counteracted with a drug called methylene blue, according to McCann, but the substance acts so quickly that the antidote often can’t help or isn’t available in In recent years, a significant increase of reports about suicidal cases due to intentional sodium nitrite intake has been described. for publishing their case series describing severe methemoglobinemia and death from intentional ingestion of sodium nitrite (1). New York: McGraw Hill; 2018:339–40. The patient was treated with amyl nitrite, sodium nitrite and sodium thiosulfate, and hyperbaric oxygen. Sodium nitrite is an oxidizing agent capable of producing profound methemoglobinemia. Advertisement 5 Story Sodium nitrite ingestion poses a considerable public health threat. on sodium nitrite self-poisoning and its antidote, methylene blue. Keywords: sodium nitrite overdose, methemoglobinemia, methylene The management of hydrogen sulphide (H2S) poisoning is sodium nitrite and oxygen. A total of 35 studies with 132 cases were enrolled, and the data were cataloged in The patient's consciousness improved and he could recall ingesting approximately 15 g sodium nitrite about 1 hour before he was brought to the authors' hospital, and he was discharged on day 7 without neurologic The established method was successfully applied to 10 authentic sodium nitrite poisoning cases, resulting in low nitrite concentrations (32. Introduction. Expand. 7 mg/L in heart blood samples) and high nitrate concentrations (298. Amyl and sodium nitrites can cause methemoglobinemia and hypotension and therefore are not recommended if carbon monoxide We identified three nitrite poisoning cases, one male and two females, from the same family. We describe a case of fatal self-poisoning with sodium nitrite; in particular, the article focuses on the autoptic and toxicological There is no specific antidote for sodium azide poisoning in current clinical use 61, 72 and only symptomatic and supportive treatment can be given. Clinical manifestations of sodium nitrite poisoning include peripheral cyanosis, headache, skin flushing, altered skin color, orthostatic hypotension with reflex tachycardia, hypoxia, altered mental status, nausea, vomiting, A recent rise in intentional ingestions and deaths from sodium nitrite poisoning has been reported in multiple countries, including Canada. We report a case of severe methemoglobinemia due to sodium nitrite poisoning. This report details the case of a 28-year-old man; the man had posted on a social network service detailing his attempt at suicide at 13:45. , with the National Poison Data System recording 47 cases of sodium nitrite poisoning from 2015 to 2020 alone, according to CMAJ. This paper examines overall suicide trends, sodium nitrite ingestion as an emerging suicide method, and the role that online forums play in sharing In recent times, there has been a concerning and noteworthy rise in the global use of sodium nitrite for suicidal purposes. Suicide attempts have increased in recent years with ingestion of sodium nitrite used for meat curing . Benowitz NL. These findings suggest that poison center surveillance underestimates confirmed deat Nitrites, as a powerful kind of oxidizing agent, can oxidize ferrous ions (Fe 2+) to ferric ions (Fe 3+), triggering the conversion of normal hemoglobin (Hb) to methemoglobin (MetHb), which loses its ability to carry oxygen, resulting in hypoxia in tissues and death in severe cases. Acute cyanide poisoning: a case report J Emerg Med. A similar trend has recently been reported in Case . This systematic review summarizes the most crucial evidence regarding the fatal toxicity of sodium nitrite. demonstrated 20 post-mortem cases in which intentional sodium nitrite ingestion was a suspected cause of death by the circumstances and biochemical analysis of post-mortem blood nitrite and nitrate levels between January 2020 and February 2022. 4 ± 29. The results of the autopsy showed general signs of asphyxia, such as intense cyanosis of the extrem Nitrates and nitrites are made up of nitrogen and oxygen and can combine with other compounds like sodium and ammonium. Our case report describes an intentional sodium nitrite ingestion with favorable outcomes. 2009–2016 - - 2017 4 23. Sodium nitrite poisoning was virtually unheard of until very recently, says Eric McGillis, a Calgary-based medical Background: In 2022, suicide ranked as the 11th leading cause of death in the United States with 49,513 deaths. Afterward, there was an annual uptrend from 2017 What is Sodium Nitrite Used For? Sodium nitrite is used for a variety of reasons. 4 ± Sodium nitrite and other inorganic nitrites are used mainly in the manufacture of dyestuffs and more recently as anticorrosives in automobile anti-freeze mixtures. The incidence of sodium nitrite self-poisoning in the United States has been trending upward since 2017. 2. Operating instructions for dilution of the toxicant were found at the scene. He continues to do well without identifiable long-term sequela. He was immediately intubated and ventilated with 100% oxygen. Clin toxicol. In the posted article, he stated that he had ingested 84 g of sodium nitrite. This scoring algorithm, which is used in the context of pharmacovigilance, was applied to attribute While toxicological data on blood nitrite concentration are scarce in forensic literature, some studies considered nitrate levels in cases of death by acute sodium nitrite toxicity [9], [17], [20]. Severe methemoglobinemia with fatal outcomes following ingestion of sodium nitrite and The conventional method for assessing sodium nitrite poisoning cases involves postmortem measurement of MetHb concentration. It contains descriptions and evaluations of toxicological studies and epidemiological investigations and provides conclusions, where possible, on the relevance of toxicity and Sodium-nitrite-related deaths represent a challenge for forensic pathologists; therefore, it is important to promptly recognize the essential features and perform the necessary and unrepeatable examinations for the correct diagnosis of the cause of death. Furthermore, a review of nitrite poisoning cases over the past 100 years shows that the old poison is still in use and poses a significant threat to society. All cases of fatal sodium nitrite ingestion were identied in the Toxicology database and autopsy reports at Forensic Science SA (FSSA). We describe a case of fatal self-poisoning following the oral ingestion of sodium nitrite with suicidal intent. e28810. Hwang C, Yeon S-H, Jung J, et al. 8% increase in the number of suicides compared to 2021. 5 g per 1 kg of Case Series We report five cases of severe methemoglobinemia secondary to large sodium nitrite ingestion that were reported to and managed by the California Poison Control System in 2019 Poison centres also do not have a clear picture of the problem because it’s not mandatory for health care workers to pass along information about the poisonings they treat. There were no cases reported to CPCS in the 5 years prior. Sodium nitrite can be toxic in high amounts for humans 3; acute nitrite intoxication can occur after ingestion of 200mg to 500mg with an incubation period commonly within one hour We would like to show you a description here but the site won’t allow us. Flow diagram of the design of the study in accordance with the PRISMA 2020 guidelines. cyanide antidote kit containing amyl nitrite, sodium nitrite, and sodium thiosulfate has not been efficacious in human poisoning cases or in animal experiments. In each case, no underlying organic diseases or injuries were identified that could have caused or contributed to death. Sodium nitrite poisoning was virtually unheard of until very recently, says Eric McGillis, a Calgary-based medical toxicologist at Alberta’s Poison and Drug Information Service. 6%. 16 In the absence of hydroxocobalamin, it is advised to administer sodium nitrite for cyanide poisoning. 0 ± 25. The patient was hypotensive and cyanotic upon EMS arrival. 1 In toxicological terms, nitrites together with other ions such as chlorates (ClO 3-), aromatic amino and nitro Sodium nitrite injectable solution and amyl nitrite crushable ampules for inhalation are components of the cyanide antidote package. Lastly, sodium nitrite has been used as effective therapeutic agent in cases of cyanide poisoning [5]. 3 mg/L in heart blood Fatal sodium nitrite poisonings are unusual in the forensic setting. Suicide by poisoning includes drug overdose, the inhalation of toxic gasses, and poisoning from pesticides and chemical substances. The case was featured on multiple news streams including People, USA Today, NBC News, and CBS. A fatal case by a suicide kit containing Documented cases of sodium nitrite toxicity are almost exclusively caused by accidental ingestion; however, self-poisoning with sodium nitrite represents an increasing trend in nitrate-related deaths. Ultimately, the established cause of death in the majority of cases were signed out as MetHb and/or sodium nitrate/nitrite toxicity (Table 1). A single intake of as little as 0. 4-Dimethylaminophenol produces a more rapid rise in methaemoglobin than sodium nitrite, 4,45 and is a commonly used cyanide antidote in Germany. It’s a common preservative often used in cured meat to preserve its shelf life. 2 g of sodium nitrite or potassium nitrite can lead to poisoning. Sodium nitrite overdose can cause severe low blood pressure (hypotension) Many cases of food poisoning never get an official diagnosis from the doctor. The patient was Among the causes of acute methemoglobinaemia are the ingestion and inhalation of over 40 oxidising substances, including nitrite, nitrate, carbon monoxide, some medicines, chlorine. 9 Oral, RR 40, SpO2 92% on 15L NRB. Medicine (Baltimore), 101 (7) (2022), p. Minyoul Kim methemoglobinemia patients prevented fatal consequences and the public should be informed about the accessibility and toxicity of sodium nitrite. • Sodium nitrite ingestion can cause significant methemoglobinemia that can be fatal without Sodium Nitrite. To highlight a recent surge in new drug deaths resulting from sodium nitrite (NaNO2) toxicity in which the post mortem blood nitrite (NO2-) and nitrate (NO3) concentrations were measured. Sodium Thiosulfate Treatment options are hydroxycobalamin, sodium thiosulfate, and amyl/sodium nitrite. due to sodium nitrite poisoning. In healthy humans, erythrocytes are continually exposed to oxidative stress from natural metabolism [ Citation 1 , Citation 7 ]. Drug-toxicity, methemoglobinaemia, hypotension, respiratory distress and tachycardia were considered to be related to the intentional overdose of sodium-nitrite [time to reactions onset not stated]. In this study, a common Griess reagent color test (MQuant™ Nitrite Test Fatal sodium nitrite poisonings are rare in the forensic context. All deaths related to ‘sodium nitrate’, ‘sodium nitrite’ and ‘methaemoglobinaemia’ at a Sydney mortuary from 2001 to August 2021 were reviewed. Moreover, organic nitrates (e. Unintentional mass sodium nitrite poisoning with a fatality. For the majority of cases (9/15) individuals were discovered deceased; 4/15 cases emergency services attended and death occurred either on route to or following hospital admission. 4 ± Introduction: Suicide by sodium nitrite poisoning (SNP) is not common. At present, FSSA does not have a validated analytical method for nitrite or methemoglobin in body fluids. In Belgium however it remains a rare We report a case of sodium nitrite poisoning in a dye factory worker who inhaled toxic fumes, leading to acute respiratory symptoms and chronic exposure signs such as nails and teeth discoloration. Nineteen cases were identified. Overdose. Fatal methemoglobinemia: A case series highlighting a new trend in intentional sodium nitrite or sodium nitrate ingestion as a method of suicide. Both hydroxycobalamin and sodium thiosulfate can be given in suspected cyanide and concomitant carbon monoxide poisonings. Severe methemoglobinemia with fatal outcomes following ingestion of sodium nitrite and intentional self-poisoning have been reported [3, 7]. Nitrite is added to certain foods to prevent the growth of Clostridium botulinum, which causes botulism poisoning. However, “the cases [have increased] exponentially over the last several years. Sodium Thiosulfate 12. In this case of cyanide poisoning the patient was exposed to smoke from a domestic fire and experienced cyanide poisoning. Our case report describes an intentional sodium Documented cases of sodium nitrite toxicity are almost exclusively caused by accidental ingestion; however, self-poisoning with sodium nitrite represents an increasing trend in nitrate-related deaths. 5 mg/L in peripheral blood samples and 20. Like in Ontario, most of these poisonings occurred in 2019 and 2020. Goldberg, PLLC cases spur bipartisan ban on sodium nitrite If you or someone you know is having suicidal thoughts or feeling at risk of suicide, it’s very important to reach out to someone immediately. year, but it increased to 8 cases in 2018. Poisoning and Drug Overdose. The results of the autopsy showed general signs of asphyxia, such as intense cyanosis of To highlight a recent surge in new drug deaths resulting from sodium nitrite (NaNO2) toxicity in which the post mortem blood nitrite (NO2-) and nitrate (NO3) concentrations were measured. It is also a corrosion inhibitor found in antifreeze [3, 4] and used as an antidote to cyanide poisoning []. 5 2018 13 76. An increasing trend in the use of sodium nitrite as a suicide agent has been reported. The presented case indicates the need for collecting a wide range of samples for toxicological analyses. 1155/2016/9013816 [PMC free article] [Google Scholar] Khan H, Barber C, & Azrael D (2024). Conclusions. It also proves that both costal cartilage and vitreous humor may serve as an alternative forensic The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of sui cide/exit. Sign in | Create an account. The first reported case of intentional sodium nitrite ingestion occurred in 1979 []. In four cases (Cases 3, 6, 7, 16) the postmortem MetHb saturation was ≤ 10%. 1016/j. This paper highlights a surge in numbers of deaths across England and Wales due to sodium nitrite toxicity. 6 mg/L in peripheral blood samples and 252. from 2013 to 2019. Clinical manifestations can include cyanosis, hypoxia, altered consciousness, dysrhythmias, and death. Health care providers should be aware of the potential toxicity of sodium nitrite, especially in large ingestions, and its treatment. These deaths exceed The established method was successfully applied to 10 authentic sodium nitrite poisoning cases, resulting in low nitrite concentrations (32. 01–0. . doi: 10. Sodium nitrite and sodium nitrate deaths by jurisdiction of investigation . There were n ocases duringthe first2months f the study, until April 2017. Poison centers offer the following precautions to prevent sodium nitrite poisoning and advice on what to do in the event of an exposure: 1. In this study, a common Griess reagent color test (MQuant™ Nitrite Test fatal in severe cases. Methylene blue is an effective but time-sensitive antidote that has the potential to save lives when administered early. Although, nitrite poisoning remains a rare Sodium nitrite (NaNO 2) is a water-soluble, white-yellow-colored crystalline powder with various practical applications including use as a food preservative, antimicrobial, and coloring agent [1, 2]. Two cases were reported in Tokyo, Japan, one in 1996 and another in 2000 [21, 22]. An increasing trend of suicide cases by SN ingestion has been exposures to the sodium nitrite, and among forty-seven cases, the reported mortality was 30%. This case highlights the critical need for strict safety regulations and The autopsy concluded that the cause of death was an acute cardio-respiratory failure in the course of suicidal sodium nitrite poisoning. Then in 1990, a dental nurse ingested a 1 g sodium nitrite tablet obtained from her workplace []. A 28-year-old man was brought to our emergency department because of transient loss of consciousness and cyanosis. Sodium nitrite causes increased methemoglobin, resulting in systemic hypoxia, metabolic acidosis, and Lilly cyanide antidote kit (Sodium thiosulphate/Amyl Nitrite/Sodium Nitrite): Apricot kernels: A rare case of cyanide toxicity; Baud FJ et al. This case report describes a fatal case of sodium nitrite and multiple drug consumption. NaNO2 is an inorganic sodium salt that has several industrial We present a series of 20 cases over 2 years in which evidence of sodium nitrite ingestion was found at the scene and supported by biochemical analysis of post-mortem blood We describe 2 cases of severe methemoglobinemia secondary to intentional sodium nitrite intoxication in suicidal attempts. Our case report describes an intentional sodium nitrite ingestion with favorable outcomes. This is facilitated either through the employment of specialized “suicide kits” or by acquiring sodium nitrite through alternative means. Between May and November of 2019, the California Poison Control System (CPCS) was consulted on 5 patients who presented after intentional ingestions of sodium nitrite, resulting in two cases of severe toxicity and three fatalities . 1. Teenagers and adults in. Sodium nitrite causes increased methemoglobin, resulting in systemic hypoxia, The estimated lethal dose of sodium nitrite in adults is approximately 2. , 1987). e. 2mL/kg in children, not to exceed 10 mL. QLD 5 29. According to the findings of the veterinary inspectorate in charge of food Fatal sodium nitrite poisonings are rare in the forensic context. 1 2 Clinical manifestations of sodium nitrite toxicity include hypotension, hypox- Sodium nitrite (NaNO 2 ) is an inorganic compound that is commonly used as a preservative (E250) in the fish and meat industry. Online forums promoting poisonings. g. Because of the relatively low NaNO 2 amount sufficient to determine toxicity, food poisonings are not infrequent. 2, 4, 5 This has been attributed to websites that promote its use for suicide and sell suicide kits. 3 mg/L in heart blood In all cases the sodium nitrite product was acquired from online vendors, which was confirmed by the patients themselves in the survival cases and family members in the fatalities. Jurisdiction of investigation Frequency Percentage . Cases are summarized in Table 1. 14,15 Sodium nitrite causes methemoglobinemia and hypotension. We report a case of an intentional fatal overdose of sodium nitrite. We highlight the proper treatment of this ingestion with intravenous methylene blue. 5 . Nitrites oxidize the iron Examining data from 2000 to 2019, researchers found ten deaths attributed to sodium nitrite toxicity, with the rate of cases increasing significantly over the study period. [Google Scholar] [5]. Gastric content was also tested for sodium nitrite in seven cases; in two cases, the concentrations were equal to 13,000 and 24,000 mg/L, in four cases, the test was positive, and in one case, it The authors mentioned that poisoning by sodium nitrite was rare, and they were not able to trace any other record of fatal poisoning in the UK. This We present a case of poisoning with sodium nitrite in three family members after eating homemade sausages given to them by their neighbor who was a butcher. Toxicology findings. Nitrite was found to be elevated in all but one case (95%), and nitrate was elevated in 17/20 (85%) cases. Large quantities of sodium nitrite can be purchased online, and recent literature has identified several cases of intentional self-poisoning, including multiple cases of Positive nitrite result of a urinalysis dipstick in a case of lethal sodium nitrite toxicity. A 37-year-old female was found in bed with a plastic bottle containing sodium nitrite and a bag containing multiple drugs and a suicide note. 2017;55:678–9. It is a powerful oxidative agent, which oxidises haemo-globin to methaemoglobin, reducing oxygen carrying capacity of erythrocytes and causing tissue hypoxia. 1), In all cases the sodium nitrite product was acquired from online vendors, which was confirmed by the patients themselves in the survival cases and family members in the fatalities. 10. A 26-year-old man and 20-year-old woman attempted suicide We present a series of 20 cases over 2 years in which evidence of sodium nitrite ingestion was found at the scene and supported by biochemical analysis of post-mortem blood nitrite and Documented cases of sodium nitrite toxicity are almost exclusively caused by accidental ingestion; however, self-poisoning with sodium nitrite represents an increasing Introduction: Sodium nitrite is an oxidizing agent capable of producing profound methemoglobinemia. Sodium nitrite is an oxidizing agent that is commonly found in processed meats, fish, and cheeses as a Background: Over the years, forensic pathology has registered the spread of new methods of suicide, such as the ingestion of sodium nitrite. ” There were no cases reported to CPCS in the 5 years prior. 5 G . 4. Efforts should be part of a comprehensive public health approach to suicide prevention. In Australia, among other countries, it was also introduced as a method to MATINET AL. 2022. Year of notification Frequency Percentage . Sodium nitrite is a cyanide antidote that is FDA approved for the treatment of acute cyanide poisoning. 3 mg/L in heart blood Nitrite was elevated in all but one case, nitrate was elevated in 12/15 (80%) cases. 41,45 When 4-DMAP was given intravenously to dogs 1 min after poisoning with a lethal dose of potassium cyanide, all the animals survived. The postmortem measurement of MetHb concentration appears to be the standard approach in cases of sodium nitrite poisoning. 2. Findings In this case series, 36 confirmed sodium nitrite deaths in 2 medical examiner jurisdictions were observed; cases increased from 2019 to 2022, and there were none from 2000 to 2018. Efforts should also be made to The autopsy concluded that the cause of death was an acute cardio-respiratory failure in the course of suicidal sodium nitrite poisoning. 63 The U. He has soot in his nares with carbonaceous sputum, Fatal incidents after poisoning with sodium nitrite have been described, mainly due to severe methaemoglobinaemia. N Engl J Med 1991; 325:1761-1766. The test results were consistent between specimens Large quantities of sodium nitrite can be purchased online, and recent literature has identified several cases of intentional self-poisoning, including multiple cases of mortality. The estimated lethal dose of sodium nitrite in adults is approximately 2. The average victim was a young White male student with a known depressive disorder (n = 125), and many victims had a history of suicidal thoughts (n = 120). Sodium nitrite, used in various industries, poses significant health risks. In this case report, we describe a fatal sodium nitrite overdose and the subsequent creation of a prehospital protocol for our large urban Emergency Medical Services system. Braitberg G. 0 ± 41. In the United States, the National Poison Data System recorded 47 cases of sodium nitrite poisoning between 2015 and 2020. Additionally, another occurrence contributing to nitrite poisoning is the recreational utilization of nitrites in The established method was successfully applied to 10 authentic sodium nitrite poisoning cases, resulting in low nitrite concentrations (32. A similar trend has also been observed in the U. Then, in 1939, three fatal cases due to sodium nitrite poisonings were reported in Journal of the American Medical Association (JAMA) [ Cases of fatal sodium nitrite poisoning due to its rarity and nonspecific presentation may present a significant challenge in forensic practice. The age range of decedents was 22–74 years (mean 51. however, that sodium nitrite comprises only a fraction of intentional poisoning cases The majority of reports on sodium nitrite poisonings have been the result of unintentional exposures. average of 7. Severe methemoglobinemia with fatal outcomes following ingestion of sodium nitrite and Sodium nitrite is also used as industrial chemical agent particularly as antifreeze admixture and to prevent corrosion of pipes and tanks [4]. and intestines, and it is primarily the nitrites that cause toxicity. For information on the storage of 'specialist antidotes', see Poisoning, emergency treatment. Sodium nitrite (NaNO 2) is a water-soluble, white-yellow-colored crystalline powder with various practical applications including use as a food preservative, antimicrobial, and coloring agent [1, 2]. Sodium nitrite is an inorganic compound usually seen as a crystalline powder that is very water sol A case of cyanide toxicity due to inhalational exposure to cyanide smoke is presented. Some even went as far as using anti-nausea medication, following The estimated lethal dose of sodium nitrite in adults is approximately 2. PDF Notably, sodium nitrite is a very similar substance to sodium nitrate, and may also cause methemoglobinemia; such toxicity is treated in a similar fashion [Citation 9–13]. 1 Sodium nitrite is also used as antifreeze admixture and to Youth Poisoning Protection Act introduced: C. After sodium nitrite therapy, sodium thiosulfate is given for severe cases only. 2 Our case occurred only 4 days after Matthew Mindler, a child actor in the movie “My Idiot Brother,” was reported to have ingested sodium nitrite. Sodium nitrite 300mg ampule (10 ml) or 10mg/kg IV should be administered over 3-5 min in adults and 0. This rate is three times higher than in a previ-ous review covering the period of 1927 to 1999. This study considered a causality assessment by applying the Naranjo Adverse Drug Reaction Probability Scale [] to validate the evidence provided by the review. It can also be used for automotive maintenance, animal control, and as part of the treatment for severe cases of cyanide poisoning. https://doi The annual suicide rate using sodium nitrite increased from 0. Elevated blood cyanide levels in victims of smoke inhalation. 1016/s0736-4679(00)00161-x Severe cases of this condition, if not treated, can be fatal. 61, 67, 71, 73 Kelocyanor Acute Cyanide Poisoning. 9, SD 21. Background: The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of suicide/exit. It is an increasingly common method of suicide and is often fatal. 11. Suicide by sodium nitrite poisoning: Findings from the National Violent Death Reporting System, 2018–2020. Lee C, Jang EJ, Yum H, et al. Food poisoning is a common illness that usually resolves within This rise in sodium nitrite overdose cases indicates the need for a simple, quick test for suspected nitrite toxicity. Forensic Sci Int, 335 (2022), p. Forensic Sci Int, 326: 110907, 2021 [4] Giustarini D, Rossi R, Milzani A, Dalle-Donne I. Rising Numbers of Sodium Nitrite Suicides since 2019 PubMed Central (PMC) Sodium nitrite is used in cured meat, but not in such a high concentration. 4 ACT <4 Sodium nitrite is a powerful oxidizing agent that causes hypotension and limits oxygen transport and delivery in the body through the formation of methemoglobin. The subsequent formation of methemoglobin (MetHb) restricts oxygen transport and utilization in the body, This rise in sodium nitrite overdose cases indicates the need for a simple, quick test for suspected nitrite toxicity. His vital signs include BP 78/40, HR 155, T 99. If you need to visit your doctor for food poisoning, they will diagnose you based on your symptoms. Background: Over the years, forensic pathology has registered the spread of new methods of suicide, such as the ingestion of sodium nitrite. The inquest heard evidence from a senior Accident & Emergency doctor about the information available from the National Poisons Information Service to emergency departments who encounter patients who have ingested sodium nitrate/nitrite. • Multiple online sources encourage use of sodium nitrite, an unrestricted and commercially available product as a reliable method of suicide. Nitrites, typically in sodium nitrite or potassium nitrite, are usually white or slightly yellow and are very similar in appearance and taste to table salt. Postmortem Methylene blue is an effective but time-sensitive antidote that has the potential to save lives when administered early. The primary purpose of this chapter is to provide public health officials, physicians, toxicologists, and other interested individuals and groups with an overall perspective on the toxicology of nitrate and nitrite. Amily nitrite, sodium nitrite and 4dimethylaminophenol are the antidotes that induce This month we take a look at nitrate poisoning. The victim, a 19-year-old woman, unknowingly ingested cyanide and presented to the Emergency Department unresponsive, in shock, and in profound metabolic acidosis. We present a case of poisoning with sodium nitrite in three family members after eating homemade sausages given to them by their neighbor who was a butcher. The test results were consistent between specimens A case series described three men and woman aged 27−51 years, who developed cyanosis, visceral congestion, pulmonary oedema, hypoxia, intra-alveolar haemorrhage, pulmonary emphysema, pulmonary stasis, brain oedema or subarachnoid haemorrhage secondary to sodium nitrite intoxication and sodium nitrite overdose following intentional suicide. It is basically used in the food-processing industry as a preservative, and in pharmacology it is used to treat cyanide poisoning. The majority of reports on sodium nitrite poisonings have been the result of Suicide with sodium nitrite is a growing phenomenon. Case Reports in Emergency Medicine, 2016, 9013816. The University Hospitals of Leicester (UHL) NHS Trust post-mortem toxicology service receives samples from 27% of Her Majesty's Coroners in England and Wales, analysing approximately Introduction. It is administered by a venous injection. According to the findings of the veterinary inspectorate in charge of food control in this case, the concentration of sodium nitrite in the homemade sausages was about 3. Adult Indications and Korea reported 14 autopsy cases from sodium nitrite poisoning. When ingested, sodium nitrite will lead to methemoglobinemia, hypotension, and arrhythmias. Self-poisoning with sodium nitrite actually represents an increasing trend in Nitrates and nitrites are widely used in the food and chemical industry. Industrial intoxication (sodium nitrite used in the antifreeze admixture) and drinking water from sodium nitrite-contaminated tanks and pipes (where sodium nitrite is used commercially to prevent corrosion of pipes) are more common causes [4]. In Australia, among other countries, it was also In general hydroxocobalamin as first-line antidotal therapy is effective and safe in acute cyanide poisoning. It should, however, be avoided in cases of trauma Sodium nitrite is commonly used in food pres-ervation and in treating cyanide toxicity. Park et al. Cyanide poisoning. 2021;17(3):475–80. Clinical symptoms included cyanosis, hypotension, and respiratory distress, with methemoglobin (MetHb) levels ranging from 5 % to 41. nitroglycerin or isosorbide dinitrate) are widely used as A 13-year-old male is brought in by EMS for altered mental status after being found in a house fire. An accidental food poisoning outbreak occurred resulting in the death of 14 of the 22 affected persons. 13 It is not necessary to wait for methemoglobin levels to come back if clinical suspicion is high. Case report: A 47-year-old female was found dead in her apartment. 0 % (the upper reporting limit for our assay), as did the 2 cases of recreational amyl nitrite use (the 1 case of isobutyl nitrite use resulted in maximum methemoglobin level of 27. Determination of nitrite and nitrate in postmortem whole blood samples of 10 sodium nitrite poisoning cases: The importance of nitrate in determining nitrite poisoning. 18 Sodium nitrite leads to higher methemoglobin levels compared to amyl nitrite, but this increase is Sodium nitrite (NaNO 2) is an easily accessible food additive (i. Among these, some cases of severe respiratory disorder developed after ingestion of excessive nitrites-added tuna were reported [4]. Case series: We report five cases of severe methemoglobinemia secondary to large sodium nitrite ingestion that were reported to and managed by the California Poison Control System in 2019, resulting in three fatalities. LAST prevention, recognition and management, sodium nitrite suicide kit poisoning, post-intubation analgesia and sedation, tetracaine for corneal abrasions, 3 step approach to coping with COVID on EM Cases EM Quick Hits podcast and more in EM Quick Hits Podcast Durão C, Pedrosa F, Dinis-Oliveira RJ. NHS Improvement Patient Safety Alert: Risk of death from unintended administration of sodium nitrite (August 2020) Cases of unintended administration of sodium nitrite have been reported, including 2 fatalities. Without any information about the circumstances of the case, it is often unrecognizable that the victim ingested sodium nitrite. Sodium nitrite for cyanide and H2S poisoning is used with the intention of causing a MetHb level of ~30% in order to dissociate the poison from the mitochondria and back into the intravascular compartment. 46 Eighteen case reports of the use of 4-DMAP have been As a chemical asphyxiant, sodium nitrite affects vital organs, especially those with high oxygen dependence, such as the brain and heart. Sodium Nitrite Suicide presented by sodium nitrate/nitrite. It identifies gaps and differences in The case of a 4-yr-old child in whom cyanide poisoning developed with extremely high blood cyanide levels after ingestion of oral laetrile (I) tablet, 12 tablets of 500 mg, successfully treated with amyl nitrate perles by intermittent inhalation followed by 5 ml of 3% sodium nitrite, and 25 ml of 25% sodium thiosulfate, given as intravenous Self-poisoning with sodium nitrite actually represents an increasing trend in nitrates' related deaths. In this case series we present 28 cases of sudden death of individuals with evidence of MetHb and/or toxic salt However, the use of sodium nitrite has recently emerged as an increasingly popular method of suicide. Cyanide binds avidly to Fe +3 of heme in the cytochromes and inhibits complex IV of the ETC. Nitrite and nitrate measurement by Griess reagent in human plasma: evaluation of interferences and From November 2020 to December 2021, there were four autopsy cases of nitrite poisoning caused by pickling salt, and 10 autopsy cases of nitrite poisoning by pure sodium nitrite. 4 ± Sodium nitrite, often mistaken for common table salt or sugar due to its similar appearance, has resulted in poisoning incidents. Sodium nitrite’s LDLo is 33-250mg/Kg, meaning a 60kg person would likely have to consume at least 2g to 15g to result in death. 7 %. Total 17 100 . 3 mg/L in heart blood This rise in sodium nitrite overdose cases indicates the need for a simple, quick test for suspected nitrite toxicity. If clinical suspicion of cyanide poisoning is high, administer sodium nitrite and sodium thiosulfate without delay and in conjunction with Presumptive identification of nitrite by Griess reagent test strips—Case reports of fatal poisoning with sodium nitrite, Journal of Analytical Toxicology, 47, 8, (746-749), (2023). Sodium nitrate is commonly used as a preservative in curing meats and ammonium nitrate is found in instant cold packets. Crossref Google Scholar. 2, 5 The United Kingdom now requires that sodium nitrite suppliers refuse “suspicious transactions Sodium nitrite (NaNO 2) is an inorganic compound that is commonly used as a preservative (E250) in the sh and meat industry. It A healthy body should have less than 1% methemoglobin; the first reported case of sodium nitrite poisoning in New Zealand in 2010 had an ante-mortem methemoglobin concentration of 82. 3; It should not be used if inhalation injury is suspected, as it needs to be converted to methemoglobin, which could be unsafe in patients with carbon monoxide toxicity. The remaining two cases gave insufficient detail regarding circumstances of death. Our case report describes an intentional sodium nitrite ingestion with The majority of reports on sodium nitrite poisonings have been the result of unintentional exposures. In the forensic pathology context, the strategy to approach intoxication cases by sodium nitrite, without any preliminary information or hint, is not straightforward. The established method was successfully applied to 10 authentic sodium nitrite poisoning cases, resulting in low nitrite concentrations (32. Series Clin Med Case Rep Rev. View PDF View article View in Scopus Google Scholar [7] Sodium nitrite causes increased methemoglobin, resulting in systemic hypoxia, metabolic acidosis, and. Sodium nitrite. A post-mortem (PM) inspection was If not available, give sodium nitrite; May be reasonable to follow either of those with sodium thiosulfate; Reasonable to administer 100% oxygen; Hydroxocobalamin 5 G. However, relying solely on methemoglobinemia to ascertain the cause of poisoning is not advisable due to its association with various other substances, and the determination of MetHb itself may present challenges. Navigating Methemoglobinemia: A Sodium Nitrite Poisoning Case Report and Therapeutic In both case-studies of EMS-treated sodium nitrite poisoning patients reported, cardiac arrest occurred in the presence of EMS, but this may not always be the case. Sodium nitrite 300 mg. The majority of reports on sodium nitrite poisonings have been the result of unintentional exposures. 161 Smoke inhalation from domestic fires and occupational exposure (metal extraction in mining, electroplating in jewelry production, photography, and plastic and rubber manufacturing) are the most common causes of cyanide poisoning. 7th ed. Sodium nitrite injection is indicated for sequential use with sodium thiosulfate for the treatment of acute cyanide poisoning that is judged to be serious or life-threatening. The intentional ingestion of sodium nitrite (NaNO 2) or sodium nitrate (NaNO 3), causing MetHb, is an uncommon and recently identified method of suicide, with the first reported case in the literature occurring in New Zealand in 2010. Introduction Sodium Nitrite Poisoning The Maryland Poison enter received a call about a patient who reportedly System (NPDS) had 47 cases of sodium nitrite exposures ( lin Toxicol (Phila). Causality Assessment. 111279. The first described cases of fatal sodium nitrite intoxication due to food poisoning date back to 1936, We present a case of poisoning with sodium nitrite in three family members after eating homemade sausages given to them by their neighbor who was a butcher. We applaud Dr. There is a Black Box Warning for this drug as shown here. Online forums were used to share knowledge on the procurement and preparation of sodium nitrite poisoning. Sodium nitrite self-poisoning is an increasingly used planned suicide method among young people. 09/100,000 person-years over the three-year period. A case of attempted homicide by cyanide ingestion is reported. 1 In toxicological terms, nitrites together with other ions such as chlorates (ClO 3-), aromatic amino and nitro Two cases of fatal methemoglobinemia caused by self-poisoning with sodium nitrite: A case report. 2000 May;18(4):441-5. A total of 260 cases were identified as suicides secondary to self-poisoning with sodium nitrite or sodium nitrate between 2018 and 2020 across 37 states and 1 territory. In Belgium however it remains a rare Introduction. Poisoning occurred most commonly in laboratory nitrite, sodium thiosulfate, and/or hydroxocobalamin were used in severely poisoned patients. Key Points. S. Sodium nitrite (NaNO 2) is an inorganic compound in the form of a white or yellow crystalline water-soluble powder. Inorganic nitrites are rarely encountered as the cause of human poisoning. A group of 10 patients suffering from moderate to severe methaemoglobinaemia after accidental intoxication with a sodium nitrite salt is described. According to the findings of the Sodium nitrite Poisoning Crime scene Suicide ABSTRACT Fatal sodium nitrite poisonings are rare in the forensic context. Provisional mortality data from 2022 indicate a 2. 5 g per 1 kg of In one case, sodium nitrite was assessed in blood with a positive result. Until 2017, there has been 1 autopsy every. The present work describes a first fatal case of sodium nitrite contained in a suicide kit that the victim acquired over the internet. Large quantities of sodium nitrite can be purchased online, and recent Sodium nitrite ingestion poses a considerable public health threat. 5 g per 1 kg of In this case report, we describe a fatal sodium nitrite overdose and the subsequent creation of a prehospital protocol for our large urban Emergency Medical Services system. The incidence of sodium nitrite self‐poisoning in the United States has been trending upward since 2017. Large quantities of sodium nitrite can be purchased online, and recent literature has identified several cases of intentional self-poisoning, including multiple cases of The established method was successfully applied to 10 authentic sodium nitrite poisoning cases, resulting in low nitrite concentrations (32. It takes approximately 12 min to generate approximately 40% of methemoglobin after intravenous administration of the recommended dose (Van Heijst et al.