Fatal Methemoglobinemia Due to Acute Inhalation of Methyl Nitrite in an Industrial Accident

Abstract

Methyl nitrite is suggested to cause methemoglobinemia by generating methemoglobin, which may be lethal when the methemoglobin concentration exceeds 70%. However, intoxication with methyl nitrite is seldom reported compared with that with other nitrites. Here, we present an industrial accident involving methyl nitrite inhalation during its synthesis process that resulted in three fatalities and one survivor. The autopsy revealed conspicuous blue-gray discoloration in various parts of the body, including the skin, airway mucosa, vessels, brain, heart, and among other areas. The toxicological tests on the deceased showed methemoglobin concentrations in the blood over the lethal level and increased nitrite ion levels in the blood, gastric contents, liver, and lung tissue compared with those in control samples. The cause of death was determined to be methemoglobinemia-induced hypoxia due to methyl nitrite inhalation. This report provides evidence that in methyl nitrite intoxication, exposure duration has a significant influence on the postmortem changes and likelihood of a fatal outcome may be related to the age of the victim. More attention is required regarding the industrial hazards of this substance.

A fatal case by a suicide kit containing sodium nitrite ordered on the internet

“…It is also important to highlight that besides sodium nitrite intoxications, methemoglobinemia may arise from a variety of etiologies including genetic, dietary, idiopathic, and methyl nitrite intoxications. 2,[29][30][31] The treatment of severe methemoglobinemia usually focus on aggressive decontamination, hyperoxic ventilation, and administration of reducing substances such as the thiazine dye methylene blue. 10 Failure to detect sodium nitrite in routine toxicological analysis can result in false negatives.…”

Nitrites: An Old Poison or a Current Hazard? Epidemiology of Intoxications Covering the Last 100 Years and Evaluation of Analytical Methods

“…Between 2010 and 2012, the inadequate labelling of packaging led to a series of accidents of unintentional ingestion of antifreeze mixtures containing sodium nitrite at the construction sites in Korea [102]. Another incident occurred in 2019 in a chemical plant during methyl nitrite synthesis resulting in four intoxications due to inhalation, among which three were fatal [103].…”

Bioamide-Decorated Polyfluoreneisocyanide: Preparation from Benzoxazine-Isocyanide Mechanochemistry Postmodification and Application as an Active Modifier for Pb2+/NO2– Electrochemical Probing

“…With the continuous development of society nowadays, heavy metal lead ion (Pb 2+ ) and nitrite (NO 2 – ) have been increasingly applied in industrial fields, and the pollution brought by them to the environment has become more and more serious. − Pb 2+ is one type of representative heavy metal ion that poses a serious threat to various living organisms due to its high toxicity and nondegradability. − NO 2 – is commonly used in the food industry as a colorant or preservative; , excessive intake of NO 2 – might cause methemoglobinemia and seriously endanger human health . Therefore, the effective detection of Pb 2+ and NO 2 – in water samples is crucial for environmental protection and human health development.…”

“…4−6 NO 2 − is commonly used in the food industry as a colorant or preservative; 7,8 excessive intake of NO 2 − might cause methemoglobinemia and seriously endanger human health. 9 Therefore, the effective detection of Pb 2+ and NO 2 − in water samples is crucial for environmental protection and human health development. Pb 2+ /NO 2 − probing methods include atomic absorption spectrometry, 10 spectrophotometric method, 11 ionic chromatography, 12 fluorescence, 13 high-performance liquid chromatography, 14 inductively coupled plasma emission spectroscopy, 15 and electrochemical detection.…”