Suicidal Fatality from Azide Ingestion

Meatherall, Robert; Oleschuk, Curtis J.

doi:10.1111/1556-4029.12857

Cited by 8 publications

(6 citation statements)

References 9 publications

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“…Azide is metabolized by the liver into nitrogen oxide and azide is eliminated by the kidneys 6 . In urine of case 2, a concentration of 4.7 µg/mL sodium azide (3.0 µg/mL azide) was measured, similar to other reported concentrations of 7.5 26 and 3.7 µg/mL 27 . In most cases, no azide was found in urine.…”

Section: Resultssupporting

confidence: 86%

Toxicological analysis of azide and cyanide for azide intoxications using gas chromatography

Bruin

Dekker

Venekamp

et al. 2020

Basic Clin Pharma Tox

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Azide is a highly toxic chemical agent to human being. Accidental, but also intentional exposure to azide occurs. To be able to confirm azide ingestion, we developed a method to identify and quantify azide in biological matrices. Cyanide was included in the method to evaluate suggested in vivo production of cyanide after azide ingestion. Azide in biological matrices was first derivatized by propionic anhydride to form propionyl azide. Simultaneously, cyanide was converted into hydrogen cyanide. After thermal rearrangement of propionyl azide, ethyl isocyanate was formed, separated together with hydrogen cyanide by gas chromatography (GC) and detected using a nitrogen phosphorous detector (NPD). The method was linear from 1.0‐100 µg/mL for both analytes, and azide was stable in human plasma at −20°C for at least 49 days. Azide was measured in the gastric content of two cases of suspected azide ingestion (case 1:1.2 mg/mL, case 2:1.5 mg/mL). Cyanide was only identified in the gastric content of case 1 (approximately 1.4 µg/mL). Furthermore, azide was quantified in plasma (19 µg/mL), serum (24 µg/mL), cell pellet (21 µg/mL) and urine (3.0 µg/mL) of case 2. This method can be used to confirm azide and cyanide exposure, and azide concentrations can be quantified in several biological matrices.

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Section: Resultssupporting

confidence: 86%

Toxicological analysis of azide and cyanide for azide intoxications using gas chromatography

Bruin

Dekker

Venekamp

et al. 2020

Basic Clin Pharma Tox

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“…Of six cases of suicidal ingestion of NaN 3 , two of the patients were found dead (Table 1(B-2) [2,[61][62][63][64][65]). The remaining four patients were hospitalized, and three died, of whom two were hypotensive and two had metabolic acidosis.…”

Section: Suicide In a Non-laboratory Setting: Peer-reviewed Papersmentioning

confidence: 99%

Sodium azide poisoning: a narrative review

Tat

Heskett

Satomi

et al. 2021

Clinical Toxicology

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Context: Sodium azide is a highly toxic chemical. Its production has increased dramatically over the last 30 years due to its widespread use in vehicular airbags, and it is available for purchase online. Thus, accidental exposure to azide or use as a homicidal or suicidal agent could be on the rise, and secondary exposure to medical personnel can occur. No antidote exists for azide poisoning. We conducted a systematic review of azide poisoning to assess recent poisoning reports, exposure scenarios, clinical presentations, and treatment strategies. Methods: We searched both medical and newspaper databases to review the literature between 01/ 01/2000 and 12/31/2020, pairing the controlled vocabulary and keyword terms "sodium azide" or "hydrazoic acid" with terms relating to exposures and outcomes, such as "ingestion," "inhalation," "exposure," "poisoning," and "death." We included all peer-reviewed papers and news articles describing human azide poisoning cases from English and non-English publications that could be identified using English keywords. Data abstracted included the number, age, and gender of cases, mode of exposure, exposure setting, azide dose and route of exposure, symptoms, outcome, and treatment modalities. Results: We identified 663 peer-reviewed papers and 303 newspaper articles. After removing duplicated and non-qualifying sources, 54 publications were reviewed describing 156 cases, yielding an average of 7.8 reported azide poisoning cases per year. This rate is three times higher than in a previous review covering the period of 1927 to 1999. Poisoning occurred most commonly in laboratory workers, during secondary exposure of medical personnel, or from a ripped airbag. Hypotension occurred commonly, in some cases requiring vasopressors and one patient received an intra-aortic ballon pump. Gastric lavage and/or activated charcoal were used for oral azide ingestion, and sodium nitrite, sodium thiosulfate, and/or hydroxocobalamin were used in severely poisoned patients. Conclusions: Recent increases in azide poisoning reports may stem from greater commercial use and availability. Treatment of systemic poisoning may require aggressive hemodynamic support due to profound hypotension. Based on mechanistic considerations, hydroxocobalamin is a rational choice for treating azide poisoning.

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“…W ostatnich dekadach ubiegłego wieku zatrucia azydkiem sodu zdarzały się znacznie częściej, pomimo ograniczonego dostępu do tego typu chemikaliów, jakkolwiek w literaturze przedmiotu odnotowano również przypadki zatruć opisane po 2000 r. [1][2][3][4][5][6]. Obecnie lista substancji chemicznych mogących mieć zastosowanie do celów samobójczych jest długa, a łatwy dostęp do informacji i możliwość zakupu przez Internet upraszczają procedurę popytu i podaży.…”

Section: Wprowadzenieunclassified

“…Despite limited access to chemicals of this type, sodium azide poisonings occurred much more frequently during the last decades of the 20 th century, however the literature on the subject also includes poisoning cases recorded after 2000 [1][2][3][4][5][6]. At present, the list of chemical substances which might be used for suicidal purposes is long, and easy access to information coupled with the possibility of making a purchase over the Internet streamline the supply and demand procedure.…”

Section: Introductionmentioning

confidence: 99%

Clinical and analytical problems of sodium azide poisonings as exemplified by a case of fatal suicidal poisoning

Rojek¹,

Hydzik²,

Gomółka³

et al. 2015

amsik

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StreszczenieCel pracy: Przedstawienie klinicznych i analitycznych aspektów związanych z zatruciami azydkiem sodu. Problemy te zostały zweryfikowane na podstawie przypadku zatrucia azydkiem sodu, unikalnego ze względu na okoliczności zdarzenia oraz opracowanie metodyczne dla celów eksperckich wymiaru sprawiedliwości. Materiał i metody: Przedmiotem badań była analiza toksykologiczna materiału biologicznego pobranego od kobiety, która w celach samobójczych zażyła w dwóch dawkach azydek sodu zakupiony przez Internet. Po pierwszej dawce postępowanie kliniczne w postaci leczenia objawowego wskazywało na możliwość wyzdrowienia, jednakże zażycie drugiej dawki ksenobiotyku -już w szpitalu -spowodowało zgon. W pracy zastosowano opracowaną do tego celu metodę chromatografii gazowej sprzężonej ze spektrometrią mas (GC-EI-MS-MS) po ekstrakcji połączonej z derywatyzacją przy użyciu bromku pentafluorobenzylowego (PFBBr). Wyniki: Pośmiertne badania toksykologiczne wykazały obecność azydku sodu we krwi (0,18 mg/l) i moczu (6,50 mg/l) kobiety. Wnioski: Przypadki zatruć azydkiem sodu są rzadkie, trudne w leczeniu, ale jak wynika z analizy piśmiennictwa w dłuższym interwale czasowym, stale się zdarzają. Dlatego też kazuistyka zatruć azydkiem sodu wraz z opisem metodyki badawczej może się stać przydatna zarówno w aspekcie klinicznym, jak i w toksykologicznym opiniowaniu sądowo-lekarskim.Słowa kluczowe: zatrucie, azydek sodu, derywatyzacja PFBBr, GC-EI-MS-MS. AbstractAim of the study: To present clinical and analytical aspects associated with sodium azide poisoning. The problems were verified on the basis of a case of sodium azide poisoning which was unique due to its circumstances and the development of an analytical method applied for medico-legal practice. Material and methods: The object of the study was a toxicological analysis of biological specimens collected from a woman who ingested two doses of sodium azide purchased over the Internet, in a suicide attempt. After the ingestion of the first dose, the clinical management in the form of symptomatic treatment indicated a possibility of recovery. However, the ingestion of a second dose of the xenobiotic, already in the hospital, caused death. Toxicological findings WprowadzenieZatrucia azydkiem sodu podobnie jak zatrucia cyjankami stanowią obecnie rzadkość. W ostatnich dekadach ubiegłego wieku zatrucia azydkiem sodu zdarzały się znacznie częściej, pomimo ograniczonego dostępu do tego typu chemikaliów, jakkolwiek w literaturze przedmiotu odnotowano również przypadki zatruć opisane po 2000 r. [1][2][3][4][5][6]. Obecnie lista substancji chemicznych mogących mieć zastosowanie do celów samobójczych jest długa, a łatwy dostęp do informacji i możliwość zakupu przez Internet upraszczają procedurę popytu i podaży.Azydek sodu ze względu na dużą toksyczność, brak odtrutki i niską skuteczność leczenia stanowi poważne zagrożenie życia, zwłaszcza po zażyciu dużych dawek. Klinicyści podkreślają [1], że podstawowe znaczenie dla procesu diagnostycznego ma wnik liwy wywiad oraz kliniczna obserw...

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Suicidal Fatality from Azide Ingestion

Cited by 8 publications

References 9 publications

Toxicological analysis of azide and cyanide for azide intoxications using gas chromatography

Toxicological analysis of azide and cyanide for azide intoxications using gas chromatography

Sodium azide poisoning: a narrative review

Clinical and analytical problems of sodium azide poisonings as exemplified by a case of fatal suicidal poisoning

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