Severe Methemoglobinemia and Death From Intentional Sodium Nitrite Ingestions

Survival after self‐poisoning with sodium nitrite: A case report

“…All cases acquired the product from online vendors. There were no cases reported to CPCS in the 5 years prior 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 (NaNO 2 ) oxidizes heme iron from the ferrous (Fe 2+ ) state to the ferric (Fe 3+ ) state. This changes the redox state of heme, causing the removal of an electron 1–5 . When oxidation occurs within the heme moiety of hemoglobin, methemoglobin is formed.…”

“…This changes the redox state of heme, causing the removal of an electron. [1][2][3][4][5] When oxidation occurs within the heme moiety of hemoglobin, methemoglobin is formed. This impairs the delivery and exchange of oxygen to tissues as methemoglobin is incapable of carrying oxygen or carbon dioxide.…”

A woman with pallor, cyanosis, and bounding peripheral pulses immediately after overdose

“… 3 Patients are frequently symptomatic with methemoglobin levels >30%, and death rapidly ensues when levels exceed 70%, although survival has been reported with levels as high as 92%. 4 Blood methemoglobin levels confirm the diagnosis, but because sodium nitrite ingestion may cause rapid cardiac arrest 5 and early methylene blue administration is associated with good outcomes, 6 severe methemoglobinemia should be diagnosed clinically to facilitate rapid methylene blue administration.…”

National Poison Data System (NPDS) review of intentional sodium nitrite ingestions 2009–2019

“…We recently published a case series of intentional sodium nitrite exposures reported to the California Poison Control System (CPCS) that resulted in two cases of severe toxicity and three deaths [8]. The cases occurred over a 7-month period in 2019 and raised concern for an emerging trend for the use of this substance as a method of suicide.…”