Sodium Nitrite Poisoning Cases

Some people have had documented cases of sodium nitrite poisoning. This page lists some of those cases and outlines their symptoms and outcomes.

If you would like to help expand this article, a list of sodium nitrite poisoning cases can be found on the [[Talk:Sodium_Nitrite_Poisoning_Cases|talk page]].

== Summary ==

{| class="wikitable"
|+ Outcomes for Sodium Nitrite Poisoning Cases
|-
! Outcome
! Cases
|-
| Survived without noted lasting damage (sequelae)
| <ref name="Aquanno">J. J. Aquanno, K. M. Chan, and D. N. Dietzler, “Accidental poisoning of two laboratory technologists with sodium nitrite.,” Clinical Chemistry, vol. 27, no. 6, pp. 1145–1146, Jun. 1981. http://clinchem.aaccjnls.org/content/27/6/1145</ref>
<ref name="Greenberg">M. Greenberg, W. B. Birnkrant, and J. J. Schiftner, “Outbreak of Sodium Nitrite Poisoning,” Am J Public Health Nations Health, vol. 35, no. 11, pp. 1217–1220, Nov. 1945. http://ajph.aphapublications.org/doi/10.2105/AJPH.35.11.1217</ref>
<ref name="Joosen">Joosen, D. et al. "A Non-Fatal Intoxication With A High-Dose Sodium Nitrate". Case Reports, vol 2014, no. may30 2, 2014, pp. bcr2014204825-bcr2014204825. BMJ, doi:10.1136/bcr-2014-204825. https://casereports.bmj.com/content/2014/bcr-2014-204825</ref>
<ref name="Chui">Chui, J. S. W. et al. "Nitrite-Induced Methaemoglobinaemia - Aetiology, Diagnosis And Treatment". Anaesthesia, vol 60, no. 5, 2005, pp. 496-500. Wiley, doi:10.1111/j.1365-2044.2004.04076.x. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2044.2004.04076.x</ref>
<ref name="Cruz">Dela Cruz, Maricel et al. "Survival After Severe Methemoglobinemia Secondary To Sodium Nitrate Ingestion". Toxicology Communications, vol 2, no. 1, 2018, pp. 21-23. ''Informa UK Limited,'' doi:10.1080/24734306.2018.1467532. https://www.tandfonline.com/doi/full/10.1080/24734306.2018.1467532</ref>
<ref name="CDC">Centers for Disease Control and Prevention (CDC). "Methemoglobinemia following unintentional ingestion of sodium nitrite--New York, 2002". ''MMWR Morb Mortal Wkly Rep.'' vol 51, no. 29, 2002, pp.639-642.</ref>
<ref name="Matteucci">Matteucci, Osvaldo et al. "Two cases of methemoglobinaemia caused by suspected sodium nitrite poisoning". ''Vet Ital.'' vol 44, no. 2, 2008, pp. 447–53. http://www.izs.it/vet_italiana/2008/44_2/447.pdf</ref>
<ref name="Raj">Raj, Pahadiya Hans et al. "A Case Of Severe Methemoglobinemia With Shock And High Saturation Gap Following Suicidal Ingestion Of Sodium Nitrite-Saved By Oral Methylene Blue". ''Toxicology International (Formerly Indian Journal Of Toxicology),'' vol 22, no. 3, 2015, p. 147. Informatics Publishing Limited, doi:10.22506/ti/2015/v22/i3/137639. http://www.i-scholar.in/index.php/ti/article/view/137639</ref>
<ref name="Ansari">Ansari, Fariheen Aisha et al. "Acute Oral Dose Of Sodium Nitrite Induces Redox Imbalance, DNA Damage, Metabolic And Histological Changes In Rat Intestine". ''PLOS ONE,'' vol 12, no. 4, 2017, p. e0175196. ''Public Library Of Science (Plos),'' doi:10.1371/journal.pone.0175196. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175196</ref>
<ref name="Dalaker">Dalaker, Vivian M. et al. "En Ung Kvinne Som Drakk Streptestreagens". ''Tidsskrift For Den Norske Legeforening,'' vol 135, no. 22, 2015, pp. 2067-2070. Norwegian Medical Association, doi:10.4045/tidsskr.15.0190. https://tidsskriftet.no/2015/12/noe-laere-av/en-ung-kvinne-som-drakk-streptestreagens</ref>
<ref name="Chui">"Sodium Nitrite Overdose". ''Reactions Weekly,'' vol 1607, no. 1, 2016, pp. 387-387. ''Springer Science And Business Media LLC,'' doi:10.1007/s40278-016-18961-3. https://link.springer.com/article/10.1007/s40278-016-18961-3</ref>
<ref name="Tung">Tung, Shu-Ping et al. "Methaemoglobinaemia Secondary To The Ingestion Of Sodium Nitrite In Mistake For Common Salt". ''Resuscitation,'' vol 70, no. 2, 2006, pp. 168-169. Elsevier BV, doi:10.1016/j.resuscitation.2006.02.017. https://linkinghub.elsevier.com/retrieve/pii/S0300957206001006</ref>
<ref name="Pope">Pope, Andrew M, and David P Rall. ''Environmental Medicine: Integrating A Missing Element Into Medicaleducation.'' National Academy Press, 1995, p. 519. https://www.nap.edu/catalog/4795/environmental-medicine-integrating-a-missing-element-into-medical-education</ref>
<ref name="Hartigan">Hartigan-Go, Kenneth Y., Nelissa Gorostiza , and Nelia P. Cortez Maramba. "Nitrite poisoning after the ingestion of cured meat." Acta Medica Philippina 32.3 (1996): 6-9. http://www.herdin.ph/index.php/component/herdin/?view=research&cid=31733</ref>
|-
| Died
| <ref name="Arbuckle">H. B. Arbuckle and O. J. Thies, “FATAL POISONING WITH SODIUM NITRITE,” Journal of the Elisha Mitchell Scientific Society, vol. 49, no. 1, pp. 176–177, 1933. https://www.jstor.org/stable/24332151</ref>
<ref name="Greenberg">M. Greenberg, W. B. Birnkrant, and J. J. Schiftner, “Outbreak of Sodium Nitrite Poisoning,” Am J Public Health Nations Health, vol. 35, no. 11, pp. 1217–1220, Nov. 1945. http://ajph.aphapublications.org/doi/10.2105/AJPH.35.11.1217</ref>
<ref name="Mcquiston">T. a. C. Mcquiston, “FATAL POISONING BY SODIUM NITRITE,” The Lancet, vol. 228, no. 5907, pp. 1153–1154, Nov. 1936. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)79085-4/abstract</ref>
<ref name="Padberg">L. R. Padberg and T. Martin, “THREE FATAL CASES OF SODIUM NITRITE POISONING,” JAMA, vol. 113, no. 19, pp. 1733–1733, Nov. 1939. https://jamanetwork.com/journals/jama/fullarticle/1158764</ref>
<ref name="Ten">W. A. Ten Brink, J. H. Wiezer, A. F. Luijpen, A. N. Van Heijst, S. A. Pikaar, and R. Seldenrijk, “Nitrite poisoning caused by food contaminated with cooling fluid,” J. Toxicol. Clin. Toxicol., vol. 19, no. 2, pp. 139–147, Apr. 1982. https://pubmed.ncbi.nlm.nih.gov/7109005/</ref>
<ref name="Gowans">Gowans, W J. "Fatal Methaemoglobinaemia In A Dental Nurse. A Case Of Sodium Nitrite Poisoning.". ''Br J Gen Pract.,'' vol 40, no. 340, 1990, pp. 470–471. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371420/</ref>
<ref name="Nushida">Hideyuki Nushida, Minori Nishiguchi. "An Autopsy Case Of Fatal Methemoglobinemia Due To Ingestion Of Sodium Nitrite". ''Journal Of Forensic Research,'' vol 06, no. 01, 2014. ''OMICS Publishing Group,'' doi:10.4172/2157-7145.1000262. https://www.omicsonline.org/open-access/an-autopsy-case-of-fatal-methemoglobinemia-due-to-ingestion-of-sodium-nitrite-2157-7145.1000262.php?aid=36065</ref>
<ref name="Harvey">Harvey, Martyn et al. "Fatal Methaemoglobinaemia Induced By Self-Poisoning With Sodium Nitrite". ''Emergency Medicine Australasia,'' vol 22, no. 5, 2010, pp. 463-465. Wiley, doi:10.1111/j.1742-6723.2010.01335.x. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1742-6723.2010.01335.x</ref>
<ref name="Saito">Saito, T. et al. "A Case Of Fatal Methemoglobinemia Of Unknown Origin But Presumably Due To Ingestion Of Nitrate". ''International Journal Of Legal Medicine,'' vol 113, no. 3, 2000, pp. 164-167. ''Springer Science And Business Media LLC,'' doi:10.1007/s004140050290. https://link.springer.com/article/10.1007/s004140050290</ref>
<ref name="Standefer">Standefer, J. C. et al. "Death Associated With Nitrite Ingestion: Report Of A Case". ''Journal Of Forensic Sciences,'' vol 24, no. 4, 1979, p. 10905J. ASTM International, doi:10.1520/jfs10905j. https://www.astm.org/doiLink.cgi?JFS10905J</ref>
<ref name="Shapiro">Shapiro, Lee et al. "Encapsulated Sodium Nitrite As A New Toxicant For Possum Control In New Zealand". ''New Zealand Journal Of Ecology,'' vol 40, no. 3, 2016, pp. 381-385. ''New Zealand Ecological Society,'' doi:10.20417/nzjecol.40.36. https://newzealandecology.org/nzje/3270</ref>
<ref name="Cvetković">Cvetković, Danica et al. "Sodium Nitrite Food Poisoning In One Family". ''Forensic Science, Medicine And Pathology,'' vol 15, no. 1, 2018, pp. 102-105. Springer Science And Business Media LLC, doi:10.1007/s12024-018-0036-1. https://link.springer.com/article/10.1007%2Fs12024-018-0036-1</ref>
<ref name="Greenberg">Greenberg, Morris et al. "Outbreak Of Sodium Nitrite Poisoning". ''American Journal Of Public Health And The Nations Health,'' vol 35, no. 11, 1945, pp. 1217-1220. American Public Health Association, doi:10.2105/ajph.35.11.1217. https://ajph.aphapublications.org/doi/10.2105/AJPH.35.11.1217</ref>
<ref name="Workum">Workum, JD et al. "[Autointoxication With ’Suicide Powder’]". ''Ned Tijdschr Geneeskd,'' vol 163, 2019, pii:D3369. https://www.ntvg.nl/artikelen/auto-intoxicatie-met-zelfmoordpoeder</ref>
<ref name="ACMT 2020">"ACMT 2020 Annual Scientific Meeting Abstracts – New York, NY". Vol 16, no. 2, 2020, pp. 116-168. ''Springer Science And Business Media LLC,'' doi:10.1007/s13181-020-00759-7. https://link.springer.com/article/10.1007/s13181-020-00759-7</ref>
<ref name="Durão">Durão, Carlos et al. "A Fatal Case By A Suicide Kit Containing Sodium Nitrite Ordered On The Internet". ''Journal Of Forensic And Legal Medicine,'' vol 73, 2020, p. 101989. ''Elsevier BV,'' doi:10.1016/j.jflm.2020.101989. https://www.sciencedirect.com/science/article/abs/pii/S1752928X20300962</ref>
<ref name="Park">
Park, Min Jee et al. "Death By Nitrite Intoxication: Report Of 14 Cases". ''Korean Journal Of Legal Medicine,'' vol 44, no. 2, 2020, pp. 96-101. ''The Korean Society For Legal Medicine (KAMJE),'' doi:10.7580/kjlm.2020.44.2.96. http://www.legalmedicine.or.kr/v1/bbs/board.php?bo_table=abstract&wr_id=618
</ref>
<ref name="Mudan">
Mudan, Anita et al. "Severe Methemoglobinemia And Death From Intentional Sodium Nitrite Ingestions". ''The Journal Of Emergency Medicine,'' 2020. ''Elsevier BV,'' doi:10.1016/j.jemermed.2020.06.031. https://www.jem-journal.com/article/S0736-4679(20)30580-1/pdf
</ref>
|}

{| class="wikitable"
|+ Symptoms in Sodium Nitrite Poisoning Cases
|-
! Symptom
! Cases
|-
| Abdominal pain (such as cramps)
| <ref name="Greenberg" /><ref name="Mcquiston" />
|-
| Ashen colored skin
| <ref name="Ten" />
|-
| Blood thinning
| <ref name="Padberg" />
|-
| Blood colored brown
| <ref name="Aquanno" /><ref name="Padberg" /><ref name="Ten" />
|-
| Cold extremities
| <ref name="Greenberg" />
|-
| Convulsions (muscle twitching) after unconsciousness
| <ref name="Ten" />
|-
| Cyanosis (blue or purple skin discoloration)
| <ref name="Aquanno" /><ref name="Greenberg" /><ref name="Mcquiston" /><ref name="Padberg" />
|-
| Diarrhea (loose or watery bowel movements)
| <ref name="Greenberg" />
|-
| Dizziness
| <ref name="Greenberg" />
|-
| Falling down (collapsing)
| <ref name="Arbuckle" /><ref name="Padberg" /><ref name="Ten" />
|-
| Feeling in head not otherwise explained
| Strange feeling in head<ref name="Ten" />
|-
| Hearing impairment
| <ref name="Ten" />
|-
| Heart palpitations
| <ref name="Aquanno" />
|-
| Hypotension (low blood pressure)
| <ref name="Greenberg" /><ref name="Ten" />
|-
| Hypothermia (low body temperature)
| <ref name="Greenberg" />
|-
| Limp limbs
| <ref name="Arbuckle" />
|-
| Nausea
| <ref name="Aquanno" />
|-
| Numbness
| <ref name="Aquanno" />
|-
| Paleness
| <ref name="Arbuckle" /><ref name="Padberg" /><ref name="Ten" />
|-
| Shock
| <ref name="Greenberg" />
|-
| Sound (throbbing or roaring)
| <ref name="Aquanno" />
|-
| Sweating (diaphoresis)
| <ref name="Aquanno" />
|-
| Tachycardia (fast heartbeat)
| <ref name="Aquanno" />
|-
| Tingling
| <ref name="Aquanno" /><ref name="Ten" />
|-
| Unconsciousness (including fainting or syncope)
| <ref name="Aquanno" /><ref name="Greenberg" /><ref name="Ten" />
|-
| Vomiting
| <ref name="Arbuckle" /><ref name="Greenberg" /><ref name="Mcquiston" /><ref name="Ten" />
|-
| Weakness
| <ref name="Aquanno" /><ref name="Arbuckle" /><ref name="Greenberg" />
|}

== Case Details ==

=== Aquanno et al. ===

* About year 1981
* Case One:
** Demographics: 21 year old woman
** Initial symptoms:
*** Began 30 minutes after eating
*** <q>[T]hrobbing-roaring sound</q>
*** <q>She started work but had to stop because of threatening syncope</q> (fainting).
*** <q>[R]apid and strong palpitations</q>
*** Tingling
*** Vomiting (but it was self-induced) <!-- Not including vomiting in symptoms table since it was self-induced -->
** Hospital symptoms:
*** Cyanosis in fingertips, lips and face
*** Blood colored chocolate brown
** Treatment:
*** Methylene blue quickly eliminated symptoms
*** <q>[I]nitial blood methemoglobin value, 34% of total hemoglobin (normal 5%), decreased to 0.9% 1 h after the initiation of treatment.</q>
** Outcome: Presumably survived
* Case Two:
** Demographics: 34 year old woman
** Initial symptoms:
*** Weakness
*** Diaphoresis (sweating)
*** Nausea
*** <q>[N]umbness and tingling in her arms and legs</q>
** Hospital symptoms:
*** Tachycardia (fast heartbeat at 130 beats per minute)
*** Cyanosis in <q>arms, legs, lips and face</q>
** Treatment:
*** Methylene blue, oxygen mask, ascorbic acid
*** <q>[I]nitial blood methemoglobin proportion, 54% of total hemoglobin, decreased to 1% 1 h after treatment had been initiated.</q>
** Outcome: Presumably survived<ref name="Aquanno" />

=== Arbuckle and Thies ===

* Demographics:
** October 28, 1932
** Huntersville, Mecklenberg County, North Carolina
** Two year old son
** A cat, to test if sodium nitrite is a poison
* Poisons:
** Unknown quantity of sodium nitrite eaten by child
** 65mg (1 grain) of sodium nitrite fed to cat
* Symptoms in child: crying, falling to ground, vomiting, paleness, weakness, limp limbs
* Outcomes:
** One person (child) died
*** Ran almost 300 feet after eating sodium nitrite
*** Died before physician arrived, not more than 15 minutes after mother found him
** Cat fed sodium nitrite and died
*** <q>To verify our opinion that sodium nitrite is a violent poison, and was the cause of this child's death, we administered 65 milligrams (1 grain) in a capsule to a cat weighing 2.6 pounds. In five minutes, the cat sprawled on the floor and began screaming. The screaming slowly died down and violent vomiting began. Four minutes later it lost control of its muscles, and in six minutes more, 15 minutes after the dose was given, the cat was dead.</q>
* After death analysis:
** Child's stomach contents were alkaline (rather than acidic) and contained sodium nitrite
** Solid particles in stomach were dark brown<ref name="Arbuckle" />

=== Greenberg et al. ===

* Demographics:
** September 25, 1944
** Lower New York City, United States
** 11 men
** Ages 60 to 80
* Poisons:
** About 0.18g of sodium nitrite in a recreated portion of oatmeal
** 0.137% sodium nitrite in a saltshaker
* Early symptoms:
** Symptoms started 5 to 30 minutes after eating
** All had similar dizziness, weakness, abdominal cramps, diarrhea
** 8 of 11 men vomited
** Five fell unconscious
* Hospital symptoms:
** Shock, sub-normal temperatures, cold extremities, low blood pressure
** Cyanosis
*** Over the whole body in one man
*** Primarily in the lips, nose, ears, fingers and toes for everyone else
** Normal urine examinations and blood counts
** Nitrites in blood
* Treatments:
** Shock treated with bed rest, heat and stimulants
** Gastric lavage
** Oxygen therapy for men with more severe cyanosis
* Outcomes:
** 10 men recovered
** One man (age 82) died a day later
*** Bronchopneumonia
*** Organs discolored mahogany brown<ref name="Greenberg" />

=== Mcquiston ===

* Demographics:
** May 31, 1936
** Linthorpe, Middlesbrough
** Man (age 45), woman (age 43), daughter (age 5)
* Poisons:
** Sodium nitrite:
*** 4.275g in man's stomach
*** 1.284g in woman's stomach
*** 0.005g in daughter's stomach (but the stomach was washed before death)
*** 1.047g in daughter's vomit
* Early symptoms:
** The three had abdominal pains, vomiting and cyanosis in the face
** Cabbage and food about the mouth
* Hospital symptoms:
** Daughter moribund on arrival
* Treatments:
** Stomach lavage, stimulants
* Outcomes:
** Two people (man and woman) died before the author arrived
*** Death estimated within one hour of their meal
** Daughter died half an hour after hospital arrival
* Symptoms after death:
** Two (woman and daughter) had brown coloration at front of pyloric end of stomach
** Two (man and woman) had:
*** Cyanosis in the lips
*** No corrosion in buccal mucous membrane
** The three:
*** Mucosa in stomachs, lining of duodenum and upper ileum were edematous and injected
*** Normal esophaguses
*** Congestion in brains, kidneys and other organs<ref name="Mcquiston" />

=== Padberg and Martin ===

* Demographics:
** October 27, 1938
** St. Louis
** Three white men preparing a meal in a room around noon:
*** JN
**** Age 55
**** 5 feet 8 inches (173 centimeters) tall
**** 140 pounds (63.5 kilogram) weight
*** TH
**** Age 65
**** 5 feet 11 inches (180 centimeters) tall
**** 175 pounds (79.5 kilogram) weight
*** AK
**** Age 70
**** 5 feet 10 inches (178 centimeters) tall
**** 180 pounds (81.6 kilograms) weight
* Poisons:
** Silver nitrite in stomach
** Sodium nitrite in stomach:
*** 0.5g in JN
*** 0.7g in TH
*** 0.1g in AK
* Early symptoms:
** AK staggered and collapsed four hours later
** AK had paleness in the face, purple lips
* Outcome: All three men died before hospital arrival
* Symptoms after death:
** All three had:
*** Cyanosis (slate-colored skin)
*** Thin, non-coagulating blood
*** Dark brown blood
*** Blood with <q>strong absorption band of methemoglobin (630) at 1:100 dilution, pH 7.1</q>
** JN:
*** White hair
*** Blue eyes
*** Left forearm amputated
*** <q>Dense fibrotic adhesions were seen in the right pleural cavity and old fibrosis was present throughout the right lung, particularly in the apex.</q>
*** <q>The capsule of the kidney was adherent and did not strip readily.</q>
** TH:
*** White hair
*** Blue eys
*** Edema of brain and lungs
*** Hypertrophy of heart
*** Moderate blood vessel sclerosis
*** Degenerative changes in kidney
** AK:
*** White hair
*** Blue eyes
*** Edema of brain and lungs
*** <q>[H]ypertrophy of the heart with atheromatous changes in the aorta and sclerosis of the coronary.</q>
*** Moderate sclerosis of arteries
*** Parenchymatous changes to kidney<ref name="Padberg" />

=== Ten Brink et al. ===

* 1980
* Netherlands
* First woman (26 years old):
** Poisons:
*** <q>large amounts of nitrites in the stomach</q>
*** <q>up to 5% sodium nitrite</q> in nasi food
** Initial symptoms:
*** Strange feeling in head
*** Fingers tingling
*** Hearing impairment
*** Rapid unconsciousness (later described as a comatose state), followed by muscle twitching, vomiting and <q>convulsion with deviation of the eyes to the left</q>
** Hospital symptoms:
*** Deep coma, no response to pain stimuli
*** Ashen colored skin
*** <q>The pupils were equal and of normal width but unreactive to light.</q>
*** <q>On funduscopy, constricted and nearly unfilled blood vessels were seen; neither hemorrhages nor congestion were observed.</q>
*** Blood pressure started at 80/55 mmHg but could not be measured soon after (<q>fulminant fall of blood pressure</q>)
*** <q>[D]ying heart</q> complexes on electrocardiogram (ECG)
*** Chocolate-brown blood color
** Treatment:
*** 10mg Diazepam (Valium) in vein
*** Intubation and respirator
** Outcome:
*** Cardiac arrest not fixed by resuscitation efforts
*** Death
** Symptoms after death:
*** Lung congestion
*** Pulmonary edema
*** Acute congestion in liver and spleen
*** Light cerebral edema
* Second woman (66 years old), six days later:
** Initial symptoms:
*** Collapsing
** Hospital symptoms:
*** Completely unresponsive
*** Paleness in face
*** Lips were ashen colored
*** <q>The pulse was regular and equal; the blood pressure was 100/65 mmHg.</q> (<q>fulminant fall of blood pressure</q>)
*** Electrocardiogram (ECG) had sinus rhythm and <q>strongly marked ischemia but no symptoms of an infarction</q>
*** Vomiting after about 15 minutes
*** <q>[S]he became comatose, and respiratory difficulties and cardiac rhythm disturbances were observed.</q>
*** Methemoglobin concentration of 80%
** Outcome:
*** Cardiac arrest not fixed by resuscitation efforts
*** Death<ref name="Ten" />

== References ==
<references />