Sodium Nitrite Intoxication and Death: Summarizing Evidence to Facilitate Diagnosis

Abstract

Background: Over the years, forensic pathology has registered the spread of new methods of suicide, such as the ingestion of sodium nitrite. Sodium nitrite causes increased methemoglobin, resulting in systemic hypoxia, metabolic acidosis, and cyanosis. Since sodium nitrite is a preservative, the ingestion of foods containing an excessive amount of this substance can also cause acute intoxication up to death. The present review is aimed at guiding health professionals in the identification and management of sodium-nitrite-related intoxications and deaths. Methods: A systematic literature search was carried out on PubMed by following the PRISMA statement’s criteria. A total of 35 studies with 132 cases were enrolled, and the data were cataloged in Microsoft Excel. To establish the causal correlation between sodium nitrite ingestion and death, the Naranjo Adverse Drug Reaction Probability Scale was used. Results: In addition to the small number of cases that have currently been published, the study demonstrated that there was a general methodological discrepancy in the diagnostic process. However, some interesting results have emerged, especially in post-mortem diagnostics. Conclusion: Sodium-nitrite-related deaths represent a challenge for forensic pathologists; therefore, it is important to promptly recognize the essential features and perform the necessary and unrepeatable examinations for the correct diagnosis of the cause of death.

Atypical Fentanyl Transdermal Patch Consumption and Fatalities: Case Report and Literature Review

“…From this point of view, in fact, the role of pathology and forensic toxicology must not end at the collection and documentation of scientific evidence for justice purposes, but should also guarantee the provision of a window on some underestimated social and health problems in order to address the necessary social and health policies [ 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ].…”

Sodium nitrite suicide and social media influence

“…17,18 In one literature review, researchers accessed a limited number of psychiatric histories in cases of intentional nitrite ingestion. 11 These histories included depression (70%), previous suicide attempts (60%), bipolar disorder (20%), schizophrenia (10%), paranoia (10%), previous self-harm attempts…”

“…Case reports from the US, Japan, and Korea have also confirmed that sodium nitrite is being ingested as a means of suicide 19-25. 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.…”

“…Healthcare professionals, legislators, and the media have taken note of a new mode of self-harm related to blogs and internet forums, which encourage those considering suicide to ingest sodium nitrite. [11][12][13][14][15] The New York Times brought wider attention to this developing phenomenon when in 2021 it published an in-depth investigation into an online forum, where participants openly encouraged suicide plans and methods, including the use of sodium nitrite. 12 The report highlighted how sodium nitrite poisoning was fast becoming a trending mode of suicide.…”

“…12 Sodium nitrite is an inorganic compound with a crystalline, odorless, yellowish-white appearance. 11 It is used primarily as a common preservative in food products and as an antidote to cyanide poisoning. 11 Recent medical literature shows the use of this substance as an aid for suicide.…”