The use of sodium nitrite for deliberate self-harm, and the online suicide market: Should we care?

Sedhai, Yub Raj; Atreya, Alok; Basnyat, Soney; Phuyal, Prabin; Pokhrel, Sagar

doi:10.1177/0025817221998119

Cited by 10 publications

(8 citation statements)

References 7 publications

(9 reference statements)

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“…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] .…”

Section: Discussionmentioning

confidence: 99%

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

Belzer,

Krasowski

2024

Toxicology Reports

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Section: Discussionmentioning

confidence: 99%

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

Belzer,

Krasowski

2024

Toxicology Reports

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“…Discussion of the use of sodium nitrite for suicide is readily accessible anywhere in the world. [13] There has been an increase in awareness in the scientific literature on the suicidal usage of sodium nitrite in many countries. [6][7][8][10][11][12] These cases warn of the grim reality that there may be numerous additional suicide cases not reported in the scientific literature.…”

Section: Discussionmentioning

confidence: 99%

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

Yoon

Kim

2022

Medicine

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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.

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“…Between 2000 and recent years, there has been a distinct lack of cases with only 1 case in New Zealand in 2010 identified in the literature [23]. However, since 2019 the number of reported suicides using sodium nitrite has significantly increased compared to previous years [24][25][26][27][28][29][30][31][32].…”

Section: Introductionmentioning

confidence: 99%

Increasing use of sodium nitrite in suicides—an emerging trend

Stephenson

Wills

Heuvel

et al. 2022

Forensic Sci Med Pathol

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Sodium nitrite (NaNO2) is a compound with broad practical applications in food preservation, automotive maintenance, and animal control. Sodium nitrite is also potentially fatal when ingested, as it interferes with the ability of red blood cells to transport oxygen. While incidents of accidental consumption have been reported in the literature, case reports of sodium nitrite being used as a pharmacological suicide agent are becoming more frequent. Therefore, a study was undertaken to evaluate trends in sodium nitrite deaths in South Australia between 2000 and 2019. All cases of fatal sodium nitrite ingestion were identified in the Toxicology database and autopsy reports at Forensic Science SA (FSSA). Ten cases of fatal sodium nitrite ingestion were identified, with the rate of cases increasing significantly over the study period (p > .001). Of the ten deaths attributed to sodium nitrite toxicity, eight were male, and two were female. The age range of decedents was 22–74 years (mean 51.9, SD 21.1), 22–74 years for males (mean 58.4, SD 18.2) and 23–29 years for females (mean 26.0, SD 4.2). Males (80%) and those with a history of depression and/or suicidal ideation (70%) were over-represented within the study population. While autopsy findings were generally consistent with the literature, scene findings emphasized the accessibility of sodium nitrite to the general public. This study highlights both a significant increasing trend in the use of sodium nitrite in suicides and important analytical limitations in the evaluation of suspected cases.

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The use of sodium nitrite for deliberate self-harm, and the online suicide market: Should we care?

Cited by 10 publications

References 7 publications

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

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

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

Increasing use of sodium nitrite in suicides—an emerging trend

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