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

Abstract

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.

Causes of acquired methemoglobinemia – A retrospective study at a large academic hospital

“…The 6 patients with intentional nitrite use all received methylene blue therapy. Increases in suicide attempts with sodium nitrite have been reported to be increasing, in part due to online information on its toxic effects coupled with availability of this compound through internet sources [37] , [53] , [54] , [55] . A set of twin infants had life-threatening methemoglobinemia from food contaminated with nitrates in a case investigated by public health authorities; both infants were treated with methylene blue [46] .…”

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

“…In addition, references from the literature found in search engines were searched for any omitted significant articles. A total of 128 individual papers [24,[29][30][31][32][34][35][36][37][39][40][41][42][43][44][45][46]48,49,53,56,57, describing in total 492 cases of intoxication were found. Analyzed cases were divided into groups according to the cause of intoxication, and how the causes of poisoning changed over the years was studied (Figure 2).…”

“…Toxics 2023, 11, 832 2 of 21 Canada [24], South Korea [34][35][36], Japan [37] Australia [38,39], Portugal [30], Spain [40], Poland [41], France [42], and Italy [43,44]. There are websites providing step-by-step instructions on how to commit suicide using sodium nitrite at home, further encouraging and describing this method as ideal due to its simplicity, quickness, and painlessness [45,46]. The origins of promoting the use of sodium nitrite as a method for suicide can be traced back to The Peaceful Pill Handbook, which recommends this method as simple, effective, peaceful, and painless [47].…”

Sodium nitrite suicide and social media influence

“…9 Case reports from the US, Japan, and Korea have also confirmed that sodium nitrite is being ingested as a means of suicide. [19][20][21][22][23][24][25] In 2022, researchers surveyed this literature for cases of sodium nitrite ingestion. 11 Their review identified 132 cases, 53 of which were for suicidal purposes.…”