Increasing use of sodium nitrite in suicides—an emerging trend

Abstract

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.

RETRACTED: Systematic Review of Fatal Sodium Nitrite Ingestion Cases: Toxicological and Forensic Implications

“…After applying these eligibility criteria, the number of articles was further reduced to 11 ( Figure 1 ) studies, which were deemed eligible for the qualitative analysis [ 15 , 16 , 17 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. The risk of bias evaluation and the applicability of primary diagnostic accuracy studies was carried out using the updated QUADAS (Quality Assessment and Diagnostic Accuracy) version, the QUADAS-2 tool, as recommended by the Agency for Healthcare Research and Quality, Cochrane Collaboration [ 22 , 23 ].…”

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] .…”

Spatio‐temporal variability of public water supply characteristics and associated health hazards for children and adults in selected locations of Ambala, India

“…Though vegetables are the important source of trace amounts of nitrates in the human body, too much nitrate in the body can cause serious ill effects. Excess amount of nitrate in drinking water may increase the risk for certain kinds of cancer, can affect oxygen levels in the blood (Stephenson et al, 2022), and may cause neural tube defects and colon cancer (Ward et al, 2018) (Table 4).…”