Death by Nitrite Intoxication: Report of 14 Cases

Abstract

Sodium nitrite intoxication is a primary cause of severe methemoglobinemia, which may be fatal. In the past, nitrite-related deaths were rare, but cases of suicide with nitrite have been increasing in number in recent years. We analyzed 14 cases of fatal nitrite intoxication from January 2013 to February 2019. There was a different trend between the cases from the past and those from recent years. The former consisted of older individuals who ingested nitrite accidentally or intentionally, while the latter comprised younger individuals who used nitrite mostly for suicide. Most individuals showed dark purple or dark brown lividity and cherry-pink discoloration of the muscles. Postmortem methemoglobin levels, which were analyzed in 5 cases, were 30%-49%. Most nitrite and nitrate concentrations showed the highest concentration in the stomach contents, and it showed that the nitrite was converted into nitrate in the blood. To conclude, methemoglobin tests using a portable oximeter and quantitative tests of nitrite and nitrate, as well as a thorough investigation of the case and scene may help determine the cause of death.

Sodium Nitrite Intoxication and Death: Summarizing Evidence to Facilitate Diagnosis

“…Mortality was significantly higher in cases of voluntary intake than in cases of involuntary intake, which was certainly due to the greater quantities of sodium nitrite that were taken in the event of a suicide attempt. The intake of an excessive but non-lethal quantity of sodium nitrite guarantees a longer survival interval, with the possibility of accessing an emergency department and receiving the appropriate therapy [ 63 ]. Another aspect is linked to the condition of solitude in which suicidal acts are carried out.…”

Two cases of fatal methemoglobinemia caused by self-poisoning with sodium nitrite

“…Teenagers and adults in their thirties were the most common (57.1%) victims, and 78.6% of total cases were confirmed or suspected suicide cases. [10] Individuals using sodium nitrite to attempt suicide easily obtain and share information s regarding these suicide methods online. [4] This is a significant public health issue since sodium nitrite is fatal when taken excessively.…”

“…Teenagers and adults in their thirties were the most common (57.1%) victims, and 78.6% of total cases were confirmed or suspected suicide cases. [10] …”

“…Until 2017, there has been 1 autopsy every year, but it increased to 8 cases in 2018. Teenagers and adults in their thirties were the most common (57.1%) victims, and 78.6% of total cases were confirmed or suspected suicide cases [10] …”

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

“…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].…”