Sodium nitrite 300mg/10ml solution for injection ampoules

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.

Abstract licence: CC BY

Sodium nitrite (NaNO2) is an odorless inorganic compound appearing as a yellowish to white powder, primarily used as a food additive. An alarming increasing trend in suicides involving NaNO2 ingestion has been recently observed. The aim of this study is to present a systematic review of intentional NaNO2 poisonings, focusing on the epidemiological characteristics of the victims, their psychiatric history, the setting and circumstances of death, as well as autopsy, histological and toxicological results. A total of 24 papers satisfied the inclusion criteria reporting 94 suicides by NaNO2 ingestion. Most victims were male (62.8%), belonging to the 13-40-year-old age group. Psychiatric history was available in 43 cases, with depression being the most reported disorder (19 cases). Autopsy and/or external examination were performed in 63 cases, mostly showing unspecific signs of asphyxia and dark discoloration of the hypostasis and blood. Methemoglobin (Met-Hb) levels in blood were available in 49 suicides, ranging from 6 to 92%. In 35 cases levels exceeded 30%, with 19 victims showing concentrations above 50%. Nitrites (NO2) and nitrates (NO3) were analyzed from different biological samples including blood, urine, gastric content, and other tissues. NO2 were detected in 44 cases, while NO3 in 30 victims. Blood was the most analyzed matrix with NO2 and NO3 concentrations ranging from 0.03 µg/mL to 372.65 µg/mL and from 0.899 µg/mL to 1,597.9 µg/mL, respectively. In addition, a case of fatal self-poisoning by oral ingestion of NaNO2, which came to the author's attention, is presented.

Abstract licence: CC BY