An autopsy case of sodium nitrite-induced methemoglobinemia with various post-mortem analyses

Hwang, Chungsu; Yeon, Seonghoon; Jung, Jinmi; Na, Joo Young

doi:10.1007/s12024-021-00378-w

Cited by 19 publications

(20 citation statements)

References 8 publications

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“…While sodium nitrite suicides are still relatively rare, the rapid increase in suicidal cases during the latter 3 years of the study period with no cases prior to this is cause for concern. A similar trend has been reported in recent years in the United States (US) [24,28], Portugal [26,27], and the Republic of Korea [40]. It is highly likely that this trend will plateau over future years rather than continuing at the same rate.…”

Section: Discussionsupporting

confidence: 78%

Increasing use of sodium nitrite in suicides—an emerging trend

Stephenson

Wills

Heuvel

et al. 2022

Forensic Sci Med Pathol

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Sodium nitrite (NaNO2) is a compound with broad practical applications in food preservation, automotive maintenance, and animal control. Sodium nitrite is also potentially fatal when ingested, as it interferes with the ability of red blood cells to transport oxygen. While incidents of accidental consumption have been reported in the literature, case reports of sodium nitrite being used as a pharmacological suicide agent are becoming more frequent. Therefore, a study was undertaken to evaluate trends in sodium nitrite deaths in South Australia between 2000 and 2019. All cases of fatal sodium nitrite ingestion were identified in the Toxicology database and autopsy reports at Forensic Science SA (FSSA). Ten cases of fatal sodium nitrite ingestion were identified, with the rate of cases increasing significantly over the study period (p > .001). Of the ten deaths attributed to sodium nitrite toxicity, eight were male, and two were female. The age range of decedents was 22–74 years (mean 51.9, SD 21.1), 22–74 years for males (mean 58.4, SD 18.2) and 23–29 years for females (mean 26.0, SD 4.2). Males (80%) and those with a history of depression and/or suicidal ideation (70%) were over-represented within the study population. While autopsy findings were generally consistent with the literature, scene findings emphasized the accessibility of sodium nitrite to the general public. This study highlights both a significant increasing trend in the use of sodium nitrite in suicides and important analytical limitations in the evaluation of suspected cases.

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Section: Discussionsupporting

confidence: 78%

Increasing use of sodium nitrite in suicides—an emerging trend

Stephenson

Wills

Heuvel

et al. 2022

Forensic Sci Med Pathol

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“…Fatal cases of voluntary intoxication via the use of suicide kits have recently been reported in the literature [1,[3][4][5][6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Recently (2020-2023), the cases described refer to ages 17-39, with many victims being under 31 years old. This makes our victim one of the youngest recorded with this modus operandi [1,[6][7][8][9]. NaNO 2 is presented as a powder resembling salt, which dissolves easily in a liquid, creating a toxic drink [12].…”

Section: Discussionmentioning

confidence: 99%

“…Nitrites are chemical elements that are naturally present in the environment. They are used in various industries in the form of sodium nitrite (NaNO 2 ), for instance, for dyeing and bleaching natural fibers, inhibiting corrosion, or for heat treatment of metals [1]. In the form of nitrated salts at 0.6%, they are used as a food additive (E250) for the preservation and maintenance of a pinkish color on cooked meats [2].…”

Section: Introductionmentioning

confidence: 99%

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Suicide of an adolescent girl with sodium nitrite ordered on the internet

Loiseau

Matheux

Sabini

et al. 2023

Journal of Forensic Sciences

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Nitrites are commonly used in the chemical, pharmaceutical, and food industries. Recently, they have been identified in cases of voluntary intoxication. We report the case of a 13‐year‐old girl who was found lifeless on her bed next to a glass containing a white powder and a bottle containing a white powder with a moistened appearance. External examination and autopsy revealed a nonspecific asphyxia syndrome, which was confirmed by the pathological analysis. Analysis of the samples revealed metoclopramide in the peripheral blood at a concentration of 0.402 mg/L (LC–HRMS). An analysis of the gastric contents was carried out after sodium nitrite was detected in the powders found near the body (Raman spectrometry). Nitrites were found in the gastric fluid at a concentration of 30.9 mg/L. Death occurred secondary to anoxia, following ingestion of nitrites; suicide kits are available on the web and nitrites are relatively easy to source and inexpensive. Nitrites are delivered in powder form to be dissolved in liquid, which may then be consumed with metoclopramide (or an alternative anti‐emetic drug) to maximize absorption and reduce emesis. The toxic effect of nitrites lies in their oxidizing power, causing the transformation of hemoglobin into methemoglobin, which, when it accumulates, induces tissue anoxia resulting in death. There has been an alarming increase in the number of cases linked to suicide using nitrites or a nitrite suicide kit. The fact that nitrites are readily available online underscores the importance of establishing effective preventive measures such as limiting the access and use of this chemical.

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“…[3] The primary toxicity mechanism of sodium nitrite is the oxidation of ferrous iron (Fe2+) of hemoglobin to methemoglobin (MetHb) containing ferric iron (Fe3+) with consequent methemoglobinemia, in which it loses its ability to bind and transport oxygen. [4] While accidental intoxication by contaminated water and food has been widely reported in the past, intentional intoxication has rarely been described in the scientific literature. [5] However, surprisingly, the number of suicides using sodium nitrite is increasing, mainly in 2021.…”

Section: Introductionmentioning

confidence: 99%

Suicide attempt using sodium nitrite ordered on the internet: Two case reports

Yoon

Kim

2022

Medicine

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Rationale: Sodium nitrite is a potent oxidizing agent that impairs oxygen transport and delivery through methemoglobin formation. Clinical manifestations are known to induce methemoglobinemia, dysrhythmia, hypotension, and even death. While accidental intoxication of sodium nitrite by contaminated water and food has previously occurred, there has been a substantial upsurge in suicide intoxication in recent years. Patient concerns: We present case reports of 2 patients who attempted suicide by sodium nitrite after ordering a “suicide powder” on the internet market. They were brought to the emergency department after attempting suicide by ingesting sodium nitrite. They experienced dyspnea, cyanosis, and mild nausea. Diagnosis: Based on their history and blood tests, methemoglobinemia was initially diagnosed. Interventions and outcomes: The patients received methylene blue antidotal therapy in the emergency department. The patients were discharged after neuropsychiatric evaluation and treatment for mental illness, suicidal ideation, and suicide attempts. They informed us of how simple and easy it was for them to buy sodium nitrite for suicidal purposes. Lessons: With widely shared information on the usage of sodium nitrite for suicide and the absence of proper regulation, the incidence of acute poisoning will increase. This increases physicians’ chances of encountering unexplained cyanosis and methemoglobinemia. Clinical suspicion of sodium nitrite intoxication is warranted in cases of unexplained cyanosis or methemoglobinemia. We want to highlight how simple and easy it is to buy sodium nitrite for suicidal purposes.

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An autopsy case of sodium nitrite-induced methemoglobinemia with various post-mortem analyses

Cited by 19 publications

References 8 publications

Increasing use of sodium nitrite in suicides—an emerging trend

Increasing use of sodium nitrite in suicides—an emerging trend

Suicide of an adolescent girl with sodium nitrite ordered on the internet

Suicide attempt using sodium nitrite ordered on the internet: Two case reports

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