Sodium nitrite detection in costal cartilage and vitreous humor – Case report of fatal poisoning with sodium nitrite

Nitrites are commonly used in the chemical, pharmaceutical, and food industries. Recently, they have been identified in cases of voluntary intoxication. We report the case of a 13‐year‐old girl who was found lifeless on her bed next to a glass containing a white powder and a bottle containing a white powder with a moistened appearance. External examination and autopsy revealed a nonspecific asphyxia syndrome, which was confirmed by the pathological analysis. Analysis of the samples revealed metoclopramide in the peripheral blood at a concentration of 0.402 mg/L (LC–HRMS). An analysis of the gastric contents was carried out after sodium nitrite was detected in the powders found near the body (Raman spectrometry). Nitrites were found in the gastric fluid at a concentration of 30.9 mg/L. Death occurred secondary to anoxia, following ingestion of nitrites; suicide kits are available on the web and nitrites are relatively easy to source and inexpensive. Nitrites are delivered in powder form to be dissolved in liquid, which may then be consumed with metoclopramide (or an alternative anti‐emetic drug) to maximize absorption and reduce emesis. The toxic effect of nitrites lies in their oxidizing power, causing the transformation of hemoglobin into methemoglobin, which, when it accumulates, induces tissue anoxia resulting in death. There has been an alarming increase in the number of cases linked to suicide using nitrites or a nitrite suicide kit. The fact that nitrites are readily available online underscores the importance of establishing effective preventive measures such as limiting the access and use of this chemical.

show abstract

“…Fatal cases of voluntary intoxication via the use of suicide kits have recently been reported in the literature [1,[3][4][5][6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Suicide of an adolescent girl with sodium nitrite ordered on the internet

Loiseau

Matheux

Sabini

et al. 2023

Journal of Forensic Sciences

View full text Add to dashboard Cite

show abstract

“…The rapid spread of information through social networking services (SNSs) and the internet has led to a sharp increase in the number of suicide attempts using sodium nitrite. [10][11][12] Additionally, the number of web forums and shadow markets devoted to explaining how to use sodium nitrite for euthanasia is increasing. Discussion of the use of sodium nitrite for suicide is readily accessible anywhere in the world.…”

Section: Discussionmentioning

confidence: 99%

Suicide attempt using sodium nitrite ordered on the internet: Two case reports

Yoon

Kim

2022

Medicine

View full text Add to dashboard Cite

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.

show abstract

“…Unfortunately, cartilage hydration affects the ability to determine the levels of water-soluble xenobiotics [ 19 ]. However, costal cartilage has been successfully used to detect nitrite ions in fatal sodium nitrite poisoning [ 24 ]. Additionally, costal cartilage, ethanol [ 25 ], and isopropanol [ 26 ] concentrations positively correlated with their concentrations in the blood.…”

Section: Introductionmentioning

confidence: 99%

Epiglottis Cartilage, Costal Cartilage, and Intervertebral Disc Cartilage as Alternative Materials in the Postmortem Diagnosis of Methanol Poisoning

Tomsia

Chełmecka

Głaz

et al. 2023

Toxics

Self Cite

View full text Add to dashboard Cite

Alternative materials for postmortem diagnosis in the case of fatal poisonings are much needed when standard materials, such as blood and urine, are unavailable. The study presents a case of fatal mass methanol intoxication resulting from industrial alcohol consumption. The study aimed to determine methanol and formic acid concentrations in epiglottis cartilage, costal cartilage, and intervertebral disc cartilage and to analyze the correlation between their concentrations in cartilage tissues and the femoral blood. Methanol and formic acid concentrations in samples collected from 17 individuals (n = 17) were estimated using gas chromatography with flame ionization detection (GC-FID). Methanol concentration in the costal cartilage correlated with its concentration in the femoral blood (r = 0.871). Similar correlations were found for epiglottis cartilage (r = 0.822) and intervertebral disc cartilage (r = 0.892). Formic acid concentration in the blood correlated only with its concentration in urine (r = 0.784) and the epiglottis (r = 0.538). Cartilage tissue could serve as an alternative material for methanol analyses in postmortem studies. Formic acid, a methanol metabolite, does not meet the requirements for its presence determination in cartilage tissues.

show abstract

Sodium nitrite detection in costal cartilage and vitreous humor – Case report of fatal poisoning with sodium nitrite

Cited by 18 publications

References 29 publications

Suicide of an adolescent girl with sodium nitrite ordered on the internet

Suicide of an adolescent girl with sodium nitrite ordered on the internet

Suicide attempt using sodium nitrite ordered on the internet: Two case reports

Epiglottis Cartilage, Costal Cartilage, and Intervertebral Disc Cartilage as Alternative Materials in the Postmortem Diagnosis of Methanol Poisoning

Contact Info

Product

Resources

About