Suicide by sodium nitrite poisoning: Findings from the National Violent Death Reporting System, 2018–2020

Khan, Harun; Barber, Catherine; Azrael, Deborah

doi:10.1111/sltb.13043

Cited by 5 publications

(1 citation statement)

References 26 publications

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“…Documented cases of sodium nitrite toxicity are almost exclusively caused by accidental ingestion; however, self-poisoning with sodium nitrite represents an increasing trend in nitrate-related deaths [ 12 , 13 ]. A similar trend has recently been reported in the United States (US) [ 14 , 15 ], Portugal [ 16 ], and the Republic of Korea [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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

Albano,

La Spina,

Buscemi

et al. 2024

Toxics

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Documented cases of sodium nitrite toxicity are almost exclusively caused by accidental ingestion; however, self-poisoning with sodium nitrite represents an increasing trend in nitrate-related deaths. This systematic review summarizes the most crucial evidence regarding the fatal toxicity of sodium nitrite. It identifies gaps and differences in the diagnostic forensic approaches and the detection methods of sodium nitrite intoxication. A total of eleven research articles were selected for qualitative and quantitative data. Most of the studies (6/11) were case reports. Fifty-three cases of fatal intoxication with sodium nitrite were chosen for the review. More research is required to develop cost-effective techniques and uniform cutoffs for blood nitrite and nitrate levels in the event of deadly sodium nitrite poisoning. There is still a lack of critical information on other matrices and the impact of time since death on toxicological results in such situations. The available evidence provides useful recommendations for forensic pathologists and health practitioners engaged in instances of sodium nitrite poisoning or death. The data should also set off alarm bells in the public health system, in prosecutor’s offices, and for policymakers so that they may undertake preventative measures to stop and restrict the unregulated market for these substances.

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Section: Introductionmentioning

confidence: 99%

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

Albano,

La Spina,

Buscemi

et al. 2024

Toxics

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Suicide and the Epidemiology of a Toxin That Kills Quickly—Data Sharing Between Public Health Agencies

Nogar,

Batista-Minaya

2024

JAMA Netw Open

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Poison control centers (PCCs) serve multiple critical roles in the United States health care system.They provide: (1) accessible health care delivery; (2) cost savings; (3) public and professional education; (4) drug and product safety research; and (5) toxico-surveillance via a National Poison Database System (NPDS). 1 The latter allows for real-time detection of anomalies and events of public health importance pertaining to trends in drug overdoses, environmental exposures, and/or adverse drug events. Much of these data are collected on individuals who are alive after the poisoning in question. Occasionally, these patients die from poisonings, and the mortality data are collected accordingly. However, mortality data surrounding highly potent toxins that cause rapid death are not reported to PCCs; rather, they are reported to medical examiners (MEs).The study by Bloom et al 2 describes the discrepancy that exists between the incidence of deaths attributed to sodium nitrite that were reported to MEs and those reported to PCCs in New York. 3 The authors also highlight a concerning trend in the scope of resources available to the public on methods of suicide by poisoning. Another recent publication in 2024 describes an increasing rate of poisoning deaths attributed to sodium nitrite that were reported by medical examiners in 37 states and Puerto Rico to the Centers for Disease Control and Prevention (CDC) via the National Violent Death Reporting System (NVDRS) from 2018 to 2022. 3 Sodium nitrite is a strong oxidizer that is used as a food preservative and color fixative. It has recently garnered attention as a widely available consumer product that is increasingly used for the purpose of suicide. This study by Bloom et al 2 highlights the existence of various suicide-tailored social media websites and blogs that promote sodium nitrite as a quick and effective means of suicide. 3 Some of these resources even describe suicide kits that aim to help users accurately calculate a lethal dose of sodium nitrite with measuring scales, as well as manage the immediate gastrointestinal symptoms of this poisoning with appropriate doses of antiemetics. 4 Other research has confirmed that sodium nitrite is one of the most popular substances mentioned on suicide blogs, and that its consumption is an emerging method of suicide. 5,6 Indeed, open access how-to internet guides on the topic of self-harm warrant intense federal and state scrutiny to curtail preventable deaths from poisoning.This study by Bloom et al 2 is also important because the real-time identification of poisoning trends, either by suicidal or homicidal intent, is essential to public safety, possibly even homeland security. Highly potent toxins such as cyanide, hydrogen sulfide, metal phosphides, azides, rotenone, aconite, fentanyl analogues, and sodium nitrite are unique not only because of their potency, but also because of their propensity to cause rapid death in humans. Alternatively, poisons such as ricin, abrin, paraquat/diquat, chlorfenapyr, radioisotopes, a...

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Comparing Confirmed Sodium Nitrite Suicide Deaths With Poison Center Surveillance Estimates

Bloom,

Sharpe,

Nulman

et al. 2024

JAMA Netw Open

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ImportanceSodium nitrite is a curing agent increasingly used for self-harm and suicide, and multiple locales have reported increasing cases. However, approaches to forensic investigation of these cases are not standardized, and current modes of surveillance in the United States may be inadequate.ObjectiveTo define a potential standard approach for identifying sodium nitrite deaths based on forensic confirmation, and compare findings based on this standard to poison center surveillance.Design, Setting, and ParticipantsThis retrospective case series of sodium nitrite exposures and deaths was conducted in 2 urban medical examiner jurisdictions in New York State from 2000 to 2022. The population-based sample included individuals from (1) medical examiner reports of decedents where the cause of death was sodium nitrite and (2) poison center reports of intentional exposures to sodium nitrite.ExposureSodium nitrite as either cause of death (medical examiner reports) or intentional exposure (poison center reports).Main Outcomes and MeasuresMedical examiner determination of sodium nitrite deaths was considered the criterion standard and relied largely on confirmatory blood nitrite testing. Poison center records were assessed for intentional exposures to sodium nitrite.ResultsIn this case series of 36 decendents, median (range) age was 28 (20-57) years; 23 (63.8%) were male; 6 (16.7%) were African-American, 5 (13.9%) were Chinese, 13 (36.1%) were White, and 4 (11.1%) had unknown race; and 6 (16.7%) were Hispanic. No deaths were found from 2000 to 2018, and yearly increases in deaths from 2019 to 2022; these deaths were largely missed by local poison center surveillance. Most cases (83.3% [n = 30]) had postmortem blood nitrite concentrations available, and multiple decedents had evidence of suicide kit recommendations from internet sources.Conclusions and RelevanceIn this case series of decedents in 2 New York medical examiner jurisdictions, sodium nitrite deaths increased yearly, and the medical examiners were able to obtain confirmatory nitrite concentrations in most cases. These findings suggest that poison center surveillance underestimates confirmed deaths from sodium nitrite; public health authorities should rely on multiple data sources when analyzing this problem, and forensic analyses should be standardized.

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Suicide by sodium nitrite poisoning: Findings from the National Violent Death Reporting System, 2018–2020

Cited by 5 publications

References 26 publications

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

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

Suicide and the Epidemiology of a Toxin That Kills Quickly—Data Sharing Between Public Health Agencies

Comparing Confirmed Sodium Nitrite Suicide Deaths With Poison Center Surveillance Estimates

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