Fatal Sodium Nitrite Poisoning: Key Considerations for Prehospital Providers

Neth, Matthew R.; Love, Jennifer S.; Horowitz, B. Zane; Shertz, Michael D.; Sahni, Ritu; Daya, Mohamud

doi:10.1080/10903127.2020.1838009

Cited by 39 publications

(29 citation statements)

References 42 publications

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“…This information was critical to medical personnel who were prepared to treat her with methylene blue and a transfusion of red blood cells to increase her tissue oxygenation. Unfortunately, she died despite aggressive therapy [5]. The MetHb concentration was 48%.…”

Section: Resultsmentioning

confidence: 99%

“…Above 50%, patients develop severe symptoms of tissue hypoxia including cardiac arrhythmia, seizures and coma (a). Literature reports suggest that levels above about 50% can be fatal and levels over 70% are generally expected to be so, [1] with some potential variability [5]. Some patients with levels of greater than 94% have survived [1].…”

Section: Resultsmentioning

confidence: 99%

“…However, several authors have reported sodium nitrite ingestions, both intentional and accidental, albeit very few, in the past few years. These reports have come from the US, Europe, and Japan [2][3][4][5][6]. The report of one victim had intractable hypoxemia (peripheral capillary oxygen saturation (SpO 2 ) as low as 74%) and brown blood upon venipuncture.…”

Section: Re Sults and Discussionmentioning

confidence: 99%

“…From the cases reported in the literature and from the history given for case #2, the onset of symptoms after ingesting a toxic amount of nitrites is very brief [5,6,7,11]. Symptoms appear to be due to tissue hypoxia and include nausea and vomiting (from gastrointestinal hypoxia), lethargy and neurologic impairment (from muscular and cerebral hypoxia), and cyanosis.…”

Section: Re Sults and Discussionmentioning

confidence: 99%

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Fatal methemoglobinemia in three suicidal sodium nitrite poisonings

Dean

Looman

Topmiller

2021

Journal of Forensic Sciences

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Nitrites are chemicals widely used as preservatives for meat and as anti-microbial agents in other food. They are commonly available as sodium, potassium, or ammonium salts. Nitrites are also abundant in the environment and are naturally occurring in some fruits and vegetables. Nitrates (-NO −3 ) on the surface of food can become nitrites (-NO −2 ) by the action of the bacterial enzyme nitrate reductase. Nitrates and nitrites are water soluble, and the presence of both forms can be minimized by washing food. Peeling the skin from vegetables and blanching them also minimizes nitrate/nitrite ingestion risk. Sodium nitrite as a pharmaceutical can be used to treat cyanide poisoning (Hope Pharmaceutical Sodium Nitrite Injection).Volatile products containing nitrites such as amyl nitrite have been used recreationally as inhalants for a euphoric effect during a state of mild hypoxia. Common exposure to small amounts is harmless.However, nitrites are able to oxidize the iron in hemoglobin from Fe +2 to Fe +3 yielding MetHb, and thereby reducing the oxygen-carrying capability of the blood. As such, when purposefully ingested in large amounts, nitrites can be fatal.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Re Sults and Discussionmentioning

confidence: 99%

Section: Re Sults and Discussionmentioning

confidence: 99%

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Fatal methemoglobinemia in three suicidal sodium nitrite poisonings

Dean

Looman

Topmiller

2021

Journal of Forensic Sciences

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“…Although there are very limited epidemiological studies regarding the emergency of new intoxication tendencies as suicide methods, the advertisement by the Internet may contribute to disseminate this burden, predisposing to be more commonly encountered in the emergency department and by forensic experts [2][3][4]. However, for most of the recent reported cases, it was impossible to know where victims found information for this suicide method [2][3][4][5].…”

Section: Editormentioning

confidence: 99%

Commentary on: Dean DE, Looman KB, Topmiller RG. Fatal methemoglobinemia in three suicidal sodium nitrite poisonings. J Forensic Sci. doi: 10.1111/1556‐4029.14689. Epub 2021 Feb 17.

Dinis-Oliveira

Durão

2021

Journal of Forensic Sciences

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Catalytic urea electrooxidation on nickel‐metal hydroxide foams for use in a simplified dialysis device

Pyka,

Bergsman,

Stuve

2024

AIChE Journal

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Electrocatalytic urea removal is a promising technology for artificial kidney dialysis and wastewater treatment. Urea electrooxidation was studied on nickel electrocatalysts modified with Cr, Mo, Mn, and Fe. Mass transfer limits were observed for urea oxidation at physiological concentrations (10 mmol L). Urea oxidation kinetics were explored at higher concentrations (200 mmol L), showing improved performance, but with lower currents per active site. A simplified dialysis model was developed to examine the relationship of mass transfer coefficients and extent of reaction on flowrate, composition, and pH of the reacting stream. For a nickel hydroxide catalyst operating at 1.45 V, 37 , and pH 7.1, the model shows a minimum geometric electrode area of 1314 cm2 is needed to remove 3.75 g urea h with a flow rate of 200 mL min for continuous operation.

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Fatal Sodium Nitrite Poisoning: Key Considerations for Prehospital Providers

Cited by 39 publications

References 42 publications

Fatal methemoglobinemia in three suicidal sodium nitrite poisonings

Fatal methemoglobinemia in three suicidal sodium nitrite poisonings

Commentary on: Dean DE, Looman KB, Topmiller RG. Fatal methemoglobinemia in three suicidal sodium nitrite poisonings. J Forensic Sci. doi: 10.1111/1556‐4029.14689. Epub 2021 Feb 17.

Catalytic urea electrooxidation on nickel‐metal hydroxide foams for use in a simplified dialysis device

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