Another suicide by sodium nitrite and multiple drugs: an alarming trend for “exit”?

Durão, Carlos; Pedrosa, Frederico; Dinis-Oliveira, Ricardo Jorge

doi:10.1007/s12024-020-00340-2

Cited by 29 publications

(33 citation statements)

References 22 publications

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“…The first two medications were likely included to minimize gastric reflux, nausea, and vomiting [3]. The same research group reported the death of a woman who ordered sodium nitrite and other medications from online merchants [2]. At least one of the victims in our case report (case #1) purchased the sodium nitrite and medications that minimize gastric reflux (famotidine and cimetidine).…”

Section: Resultsmentioning

confidence: 99%

“…However, several authors have reported sodium nitrite ingestions, both intentional and accidental, albeit very few, in the past few years. These reports have come from the US, Europe, and Japan [2][3][4][5][6]. The report of one victim had intractable hypoxemia (peripheral capillary oxygen saturation (SpO 2 ) as low as 74%) and brown blood upon venipuncture.…”

Section: Re Sults and Discussionmentioning

confidence: 99%

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Fatal methemoglobinemia in three suicidal sodium nitrite poisonings

Dean

Looman

Topmiller

2021

Journal of Forensic Sciences

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Nitrites are chemicals widely used as preservatives for meat and as anti-microbial agents in other food. They are commonly available as sodium, potassium, or ammonium salts. Nitrites are also abundant in the environment and are naturally occurring in some fruits and vegetables. Nitrates (-NO −3 ) on the surface of food can become nitrites (-NO −2 ) by the action of the bacterial enzyme nitrate reductase. Nitrates and nitrites are water soluble, and the presence of both forms can be minimized by washing food. Peeling the skin from vegetables and blanching them also minimizes nitrate/nitrite ingestion risk. Sodium nitrite as a pharmaceutical can be used to treat cyanide poisoning (Hope Pharmaceutical Sodium Nitrite Injection).Volatile products containing nitrites such as amyl nitrite have been used recreationally as inhalants for a euphoric effect during a state of mild hypoxia. Common exposure to small amounts is harmless.However, nitrites are able to oxidize the iron in hemoglobin from Fe +2 to Fe +3 yielding MetHb, and thereby reducing the oxygen-carrying capability of the blood. As such, when purposefully ingested in large amounts, nitrites can be fatal.

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Section: Resultsmentioning

confidence: 99%

Section: Re Sults and Discussionmentioning

confidence: 99%

Fatal methemoglobinemia in three suicidal sodium nitrite poisonings

Dean

Looman

Topmiller

2021

Journal of Forensic Sciences

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“…These new cases raise up our recent concern since we also detected at two cases in a very short period [2,3]. While accidental intoxications by contaminated water and food have been reported throughout the last years, intentional intoxication cases by sodium nitrite are becoming motive of alert.…”

Section: Editormentioning

confidence: 71%

“…Although there are very limited epidemiological studies regarding the emergency of new intoxication tendencies as suicide methods, the advertisement by the Internet may contribute to disseminate this burden, predisposing to be more commonly encountered in the emergency department and by forensic experts [2][3][4]. However, for most of the recent reported cases, it was impossible to know where victims found information for this suicide method [2][3][4][5].…”

Section: Editormentioning

confidence: 99%

“…On other point of view, these cases might perhaps be already happening before but failure to include sodium nitrite in regular toxicological analysis it may be hypothesized some previous false-negative results. In this regard, the inclusion of methemoglobin, nitrite, and nitrate quantification should be considered if clinical and crime scene is particularly suggestive [2,3]. Indeed, this product is much more controlled and analyzed in food regulatory toxicology, and some forensic laboratories do not have yet included validated techniques for analysis in their portfolio as they have for medicines, psychoactive substances, pesticides, and other xenobiotics.…”

Section: Editormentioning

confidence: 99%

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Commentary on: Dean DE, Looman KB, Topmiller RG. Fatal methemoglobinemia in three suicidal sodium nitrite poisonings. J Forensic Sci. doi: 10.1111/1556‐4029.14689. Epub 2021 Feb 17.

Dinis-Oliveira

Durão

2021

Journal of Forensic Sciences

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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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Another suicide by sodium nitrite and multiple drugs: an alarming trend for “exit”?

Cited by 29 publications

References 22 publications

Fatal methemoglobinemia in three suicidal sodium nitrite poisonings

Fatal methemoglobinemia in three suicidal sodium nitrite poisonings

Commentary on: Dean DE, Looman KB, Topmiller RG. Fatal methemoglobinemia in three suicidal sodium nitrite poisonings. J Forensic Sci. doi: 10.1111/1556‐4029.14689. Epub 2021 Feb 17.

Increasing use of sodium nitrite in suicides—an emerging trend

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