Sodium azide poisoning: a narrative review

Abstract

Context: Sodium azide is a highly toxic chemical. Its production has increased dramatically over the last 30 years due to its widespread use in vehicular airbags, and it is available for purchase online. Thus, accidental exposure to azide or use as a homicidal or suicidal agent could be on the rise, and secondary exposure to medical personnel can occur. No antidote exists for azide poisoning. We conducted a systematic review of azide poisoning to assess recent poisoning reports, exposure scenarios, clinical presentations, and treatment strategies. Methods: We searched both medical and newspaper databases to review the literature between 01/ 01/2000 and 12/31/2020, pairing the controlled vocabulary and keyword terms "sodium azide" or "hydrazoic acid" with terms relating to exposures and outcomes, such as "ingestion," "inhalation," "exposure," "poisoning," and "death." We included all peer-reviewed papers and news articles describing human azide poisoning cases from English and non-English publications that could be identified using English keywords. Data abstracted included the number, age, and gender of cases, mode of exposure, exposure setting, azide dose and route of exposure, symptoms, outcome, and treatment modalities. Results: We identified 663 peer-reviewed papers and 303 newspaper articles. After removing duplicated and non-qualifying sources, 54 publications were reviewed describing 156 cases, yielding an average of 7.8 reported azide poisoning cases per year. This rate is three times higher than in a previous review covering the period of 1927 to 1999. Poisoning occurred most commonly in laboratory workers, during secondary exposure of medical personnel, or from a ripped airbag. Hypotension occurred commonly, in some cases requiring vasopressors and one patient received an intra-aortic ballon pump. Gastric lavage and/or activated charcoal were used for oral azide ingestion, and sodium nitrite, sodium thiosulfate, and/or hydroxocobalamin were used in severely poisoned patients. Conclusions: Recent increases in azide poisoning reports may stem from greater commercial use and availability. Treatment of systemic poisoning may require aggressive hemodynamic support due to profound hypotension. Based on mechanistic considerations, hydroxocobalamin is a rational choice for treating azide poisoning.

Potential therapies for sodium azide intoxication; a case report and review of the literature

“…Health care workers are at risk of secondary exposure during treatment of intoxicated patients, especially when performing gastric lavage. However, current available literature showed no increased mortality after secondary exposure, as demonstrated by Tat et al 28 Although the majority of exposed personnel did not have any complaints, one had immediate clinical features (dizziness, dyspnea, headache, fatigue and ocular irritation) after exposure. 29 In another case, two health care workers required time off due to stress and fatigue.…”

“…Rapid degradation and a time-consuming process make it even more challenging to quantify the amount of sodium azide and therefore is of no help in the treatment of a patient with a suspected intoxication with sodium azide. 4 A recently published review by Tat et al 28 only recommend the use of hydroxycobolamin as a potential treatment option. However, based on the available literature as described above, limited effects can be expected.…”

Comparative Biochemical Profiling of Aluminum Chloride and Sodium Azide Induced Neuroinflammation and Cardiometabolic Disturbance

“…33 NaN 3 is a highly toxic compound, and exposure to NaN 3 poses a risk of death. 12 Researchers have proven that a high dose of NaN 3 can potentially cause the toxic damage to numerous tissues and organs. 34 This study also found that exposure to NaN 3 (17 mg/kg/day) can cause cardiac cell disarrangement, necrosis, and shrinkage of islets of Langerhans after H&E staining of heart and pancreatic tissues, respectively (Figures 8 and 9).…”

Versatile enzymology and heterogeneous phenotypes in cobalamin complementation type C disease

“…(B) Correlation between the Co-N ax bond length and the pK base-off of cobalamins with various b-ligands owing to the trans-effect (De March et al, 2012March et al, ). et al, 2020 and azide (Tat et al, 2021) poisoning. Aquacobalamin forms a complex with isoniazid (isonicotinic acid hydrazide) (Tumakov et al, 2017), which is one of the most effective antituberculosis drugs.…”

“…have shown that cobinamide was significantly more efficacious than hydroxocobalamin when compared at equal mg/kg dosages ( Bebarta et al., 2017 ). Hydroxocobalamin or/and cobinamide are also the rational choices for treating methyl mercaptan ( Hendry-Hofer et al., 2020 ) and azide ( Tat et al., 2021 ) poisoning. Aquacobalamin forms a complex with isoniazid (isonicotinic acid hydrazide) ( Tumakov et al., 2017 ), which is one of the most effective antituberculosis drugs.…”