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Sodium Nitrite Ingestion: an Emerging Trend in Suicide Attempts Shared via Online Communities

      We applaud Dr. Mudan et al. for publishing their case series describing severe methemoglobinemia and death from intentional ingestion of sodium nitrite (
      • Mudan A.
      • Repplinger D.
      • Lebin J.
      • Lewis J.
      • Vohra R.
      • Smollin C.
      Severe methemoglobinemia and death from intentional sodium nitrite ingestions.
      ). Our medical toxicology service has encountered a similar series of patients in the past 12 months and wish to add our experience. Cases are summarized in Table 1.
      Table 1Summary of Sodium Nitrite Poisoning Cases
      Case No. Age (y) Sex Estimated IngestedAmount (g) Initial Blood Pressure (mm Hg) Initial Heart Rate (beats/min) Initial Oxygen Saturation (%) Hemoglobin (g/dL) Peak Methemoglobin Level (%) Methylene Blue Dose (mg/kg) Outcome
      1 17 F NR 0/0 0 79 NR 84 1 Deceased
      2 35 M NR 90/70 40–59 80 NR NR 2
      Estimated dose, see case details.
      Deceased
      3 17 F 21 115/74 130–140 84 13.3 >28 1 Survived
      4 24 M NR 116/54 140 87 15.3 69 2 Survived
      5 22 M NR 67/36 102 80 7.4 30
      Level obtained after methylene blue treatment.
      4 Deceased
      F = female; M = male; NR = not recorded.
      Estimated dose, see case details.
      Level obtained after methylene blue treatment.
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      References

        • Mudan A.
        • Repplinger D.
        • Lebin J.
        • Lewis J.
        • Vohra R.
        • Smollin C.
        Severe methemoglobinemia and death from intentional sodium nitrite ingestions.
        J Emerg Med. 2020; 59: e85-e88
        • Theobald J.L.
        • Spoelhof R.
        • Pallasch E.M.
        • Mycyk M.B.
        The beef jerky blues: methemoglobinemia from home cured meat.
        Pediatr Emerg Care. 2018; 34: e122-e123
        • Katabami K.
        • Hayakawa M.
        • Gando S.
        Severe methemoglobinemia due to sodium nitrite poisoning.
        Case Rep Emerg Med. 2016; 2016: 9013816
        • Benowitz N.L.
        Nitrates and nitrites.
        in: Olson K.R. Poisoning and Drug Overdose. 7th ed. McGraw Hill, New York2018: 339-340

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