Fatal methemoglobinemia: A case series highlighting a new trend in intentional sodium nitrite or sodium nitrate ingestion as a method of suicide

Hickey, Tyler Bruce Malcolm; Macneil, Janesalodof; Hansmeyer, Candice; Pickup, Michael

doi:10.1016/j.forsciint.2021.110907

Cited by 37 publications

(30 citation statements)

References 25 publications

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“…ingestion of sodium nitrite for suicide has been increasingly reported. [6][7][8][9][10] One case series of five patients with methaemoglobinemia in New York identified improperly labelled sodium nitrite salt as the culprit, with measured levels of sodium nitrite in the food exceeding 3000 parts per million; the US Food and Drug Administration legal limit for sodium nitrite in prepared meats is 200 parts per million. 7 The reported lethal dose of ingested sodium nitrite has ranged from 0.7 g to 6 g. 11 Sodium nitrite is readily available as pure granules via online retailers and its use in suicide has been discussed in online forums.…”

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confidence: 99%

Fatal methaemoglobinemia due to intentional sodium nitrite ingestion

2022

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confidence: 99%

Fatal methaemoglobinemia due to intentional sodium nitrite ingestion

2022

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“…[5] However, surprisingly, the number of suicides using sodium nitrite is increasing, mainly in 2021. [6][7][8] Currently, in many countries, lethal amounts of sodium nitrite can be purchased for only a few dollars through online sales without proper regulation. [8] We present case reports of 2 patients who attempted suicide using sodium nitrite ordered on the internet.…”

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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“…Self-poisoning from ingested nitrites is an uncommon form of suicide [1]. However, several cases have already been reported [1][2][3][4][5]. Sodium nitrite shares similar characteristics to typical table salt and is cheap.…”

Section: Introductionmentioning

confidence: 99%

“…Symptoms of intoxication appear quickly and include nausea, vomiting, lethargy, coma and bradysystolic cardiac arrest. Post-mortem body examination shows a typical cyanosis pattern, with bluegray color in different parts of the body and a characteristic "chocolate" colored blood [2], [5]. Conclusions: Besides the rapid decrease in oxygen transport, the pathways involved in nitrite intoxications are still to be explored.…”

Section: Introductionmentioning

confidence: 99%