Two cases of fatal methemoglobinemia caused by self-poisoning with sodium nitrite: A case report
Sodium nitrite intoxication reportedly causes severe methemoglobinemia. Recent studies reported that most clinically significant cases resulted from intentional exposure in suicidal attempts. We describe 2 cases of severe methemoglobinemia secondary to intentional sodium nitrite intoxication in suic...
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Published in | Medicine (Baltimore) Vol. 101; no. 7; p. e28810 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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United States
Lippincott Williams & Wilkins
18.02.2022
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Abstract | Sodium nitrite intoxication reportedly causes severe methemoglobinemia. Recent studies reported that most clinically significant cases resulted from intentional exposure in suicidal attempts. We describe 2 cases of severe methemoglobinemia secondary to intentional sodium nitrite intoxication in suicidal attempts.
A 26-year-old man and 20-year-old woman attempted suicide by taking sodium nitrite, and were brought to the emergency department.
The male patient collapsed at the scene. He ingested approximately 18 g of sodium nitrate, and his methemoglobin level was 90.3%. The female patient was conscious, but was cyanotic. She ingested approximately 12.5 g of sodium nitrite, and her methemoglobin level was 54.6%.
The male patient received advanced cardiac life support in the emergency department. Methylene blue was immediately administered for the female patient.
The male patient died despite aggressive resuscitation. The female patient's cyanosis resolved, and her methemoglobin level decreased to 1.2% 3 hours later.
The immediate administration of methylene blue in severe methemoglobinemia patients prevented fatal consequences. The public should be informed about the accessibility and toxicity of sodium nitrite. |
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AbstractList | Abstract Rationale: Sodium nitrite intoxication reportedly causes severe methemoglobinemia. Recent studies reported that most clinically significant cases resulted from intentional exposure in suicidal attempts. We describe 2 cases of severe methemoglobinemia secondary to intentional sodium nitrite intoxication in suicidal attempts. Patients concerns: A 26-year-old man and 20-year-old woman attempted suicide by taking sodium nitrite, and were brought to the emergency department. Diagnosis: The male patient collapsed at the scene. He ingested approximately 18 g of sodium nitrate, and his methemoglobin level was 90.3%. The female patient was conscious, but was cyanotic. She ingested approximately 12.5 g of sodium nitrite, and her methemoglobin level was 54.6%. Interventions: The male patient received advanced cardiac life support in the emergency department. Methylene blue was immediately administered for the female patient. Outcomes: The male patient died despite aggressive resuscitation. The female patient's cyanosis resolved, and her methemoglobin level decreased to 1.2% 3 hours later. Lessons: The immediate administration of methylene blue in severe methemoglobinemia patients prevented fatal consequences. The public should be informed about the accessibility and toxicity of sodium nitrite. Sodium nitrite intoxication reportedly causes severe methemoglobinemia. Recent studies reported that most clinically significant cases resulted from intentional exposure in suicidal attempts. We describe 2 cases of severe methemoglobinemia secondary to intentional sodium nitrite intoxication in suicidal attempts. A 26-year-old man and 20-year-old woman attempted suicide by taking sodium nitrite, and were brought to the emergency department. The male patient collapsed at the scene. He ingested approximately 18 g of sodium nitrate, and his methemoglobin level was 90.3%. The female patient was conscious, but was cyanotic. She ingested approximately 12.5 g of sodium nitrite, and her methemoglobin level was 54.6%. The male patient received advanced cardiac life support in the emergency department. Methylene blue was immediately administered for the female patient. The male patient died despite aggressive resuscitation. The female patient's cyanosis resolved, and her methemoglobin level decreased to 1.2% 3 hours later. The immediate administration of methylene blue in severe methemoglobinemia patients prevented fatal consequences. The public should be informed about the accessibility and toxicity of sodium nitrite. RATIONALESodium nitrite intoxication reportedly causes severe methemoglobinemia. Recent studies reported that most clinically significant cases resulted from intentional exposure in suicidal attempts. We describe 2 cases of severe methemoglobinemia secondary to intentional sodium nitrite intoxication in suicidal attempts. PATIENTS CONCERNSA 26-year-old man and 20-year-old woman attempted suicide by taking sodium nitrite, and were brought to the emergency department. DIAGNOSISThe male patient collapsed at the scene. He ingested approximately 18 g of sodium nitrate, and his methemoglobin level was 90.3%. The female patient was conscious, but was cyanotic. She ingested approximately 12.5 g of sodium nitrite, and her methemoglobin level was 54.6%. INTERVENTIONSThe male patient received advanced cardiac life support in the emergency department. Methylene blue was immediately administered for the female patient. OUTCOMESThe male patient died despite aggressive resuscitation. The female patient's cyanosis resolved, and her methemoglobin level decreased to 1.2% 3 hours later. LESSONSThe immediate administration of methylene blue in severe methemoglobinemia patients prevented fatal consequences. The public should be informed about the accessibility and toxicity of sodium nitrite. |
Author | Mun, Sung Hoon Chai, Hyun Seok Kim, Young Min Park, Gwan Jin Lee, Ji Han Kim, Sang Chul |
AuthorAffiliation | Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea 776, 1st Sunwhan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do, Korea |
AuthorAffiliation_xml | – name: Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea 776, 1st Sunwhan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do, Korea |
Author_xml | – sequence: 1 givenname: Sung Hoon surname: Mun fullname: Mun, Sung Hoon organization: Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea 776, 1st Sunwhan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do, Korea – sequence: 2 givenname: Gwan Jin orcidid: 0000-0001-7153-9909 surname: Park fullname: Park, Gwan Jin – sequence: 3 givenname: Ji Han surname: Lee fullname: Lee, Ji Han – sequence: 4 givenname: Young Min surname: Kim fullname: Kim, Young Min – sequence: 5 givenname: Hyun Seok surname: Chai fullname: Chai, Hyun Seok – sequence: 6 givenname: Sang Chul surname: Kim fullname: Kim, Sang Chul |
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Cites_doi | 10.1016/j.jemermed.2020.06.031 10.1016/S0196-0644(99)70167-8 10.1080/24734306.2018.1467532 10.1111/j.1365-2044.2004.04076.x 10.7580/kjlm.2020.44.2.96 |
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References | Centers for Disease Control Prevention (R2-20240803) 2002; 51 Dela Cruz (R5-20240803) 2018; 2 Mudan (R4-20240803) 2020; 59 Caglar (R8-20240803) 2016; 3 Katabami (R7-20240803) 2016; 2016 Park (R10-20240803) 2020; 44 Chui (R9-20240803) 2005; 60 Wright (R6-20240803) 1999; 34 |
References_xml | – volume: 59 start-page: e85 year: 2020 ident: R4-20240803 article-title: Severe methemoglobinemia and death from intentional sodium nitrite ingestions publication-title: J Emerg Med doi: 10.1016/j.jemermed.2020.06.031 contributor: fullname: Mudan – volume: 34 start-page: 646 year: 1999 ident: R6-20240803 article-title: Methemoglobinemia: etiology, pharmacology, and clinical management publication-title: Ann Emerg Med doi: 10.1016/S0196-0644(99)70167-8 contributor: fullname: Wright – volume: 2 start-page: 21 year: 2018 ident: R5-20240803 article-title: Survival after severe methemoglobinemia secondary to sodium nitrate ingestion publication-title: Toxicol Commun doi: 10.1080/24734306.2018.1467532 contributor: fullname: Dela Cruz – volume: 51 start-page: 639 year: 2002 ident: R2-20240803 article-title: Methemoglobinemia following unintentional ingestion of sodium nitrite publication-title: MMWR Morb Mortal Wkly Rep contributor: fullname: Centers for Disease Control Prevention – volume: 3 start-page: 155 year: 2016 ident: R8-20240803 article-title: Severe methemoglobinemia due to nitrite intoxication in a child who was misdiagnosed with sepsis publication-title: Cocuk Acil ve Yogun Bakim contributor: fullname: Caglar – volume: 60 start-page: 496 year: 2005 ident: R9-20240803 article-title: Nitrite-induced methaemoglobinaemia - aetiology, diagnosis and treatment publication-title: Anaesthesia doi: 10.1111/j.1365-2044.2004.04076.x contributor: fullname: Chui – volume: 2016 start-page: 9013816 year: 2016 ident: R7-20240803 article-title: Severe methemoglobinemia due to sodium nitrite poisoning publication-title: Case Rep Emerg Med contributor: fullname: Katabami – volume: 44 start-page: 96 year: 2020 ident: R10-20240803 article-title: Death by nitrite intoxication: report of 14 cases publication-title: Korean J Legal Med doi: 10.7580/kjlm.2020.44.2.96 contributor: fullname: Park |
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Snippet | Sodium nitrite intoxication reportedly causes severe methemoglobinemia. Recent studies reported that most clinically significant cases resulted from... Abstract Rationale: Sodium nitrite intoxication reportedly causes severe methemoglobinemia. Recent studies reported that most clinically significant cases... RATIONALESodium nitrite intoxication reportedly causes severe methemoglobinemia. Recent studies reported that most clinically significant cases resulted from... |
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SubjectTerms | Clinical Case Report Cyanosis - chemically induced Female Humans Male Methemoglobinemia - chemically induced Methylene Blue - therapeutic use Sodium Nitrite |
Title | Two cases of fatal methemoglobinemia caused by self-poisoning with sodium nitrite: A case report |
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