Sodium Nitrite Poisoning

Aka: Sodium Nitrite Poisoning, Sodium Nitrite Toxicity, Sodium Nitrate Poisoning, Sodium Nitrate Toxicity

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II. Pathophysiology

  1. Sodium Nitrite Toxicity
    1. Results in oxidative damage and risk of Methemoglobinemia
    2. Vasodilator properties, especially via Nitrous Oxide production resulting in Hypotension
  2. Sodium Nitrite has recent use as an intentional suicidal Overdose (promoted in online Suicide kits)
    1. Large ingestions (grams) result in Methemoglobinemia
  3. Contrast Sodium Nitrite with Sodium Nitrate (NaNO3)
    1. Sodium Nitrate is colorless crystal or powder
    2. Sodium Nitrate is a preservative used for cheese, meats and fish (and naturally present in vegetables)
    3. Maximal daily recommended intake is 3.7 mg Nitrate ion/day or 5 mg Sodium nitrate per kg
    4. Sodium Nitrate appears safe at typical doses
      1. However, 5% of ingested nitrate is converted to the toxic Sodium nitrite
      2. Very large Sodium Nitrate ingestions (e.g. >40 to 300 mg NO3/kg) may be fatal

III. Symptoms

  1. Nausea or Vomiting
  2. Diarrhea
  3. Headache
  4. Dyspnea

IV. Signs

  1. Altered Level of Consciousness to coma
  2. Tachypnea or severe respiratory distress
  3. Seizures
  4. Hypotension
  5. Flushing
  6. Cyanosis

V. Labs

  1. See Unknown Ingestion
  2. Methemoglobin Level may be increased to >50 to 70%
  3. Arterial Blood Gas (ABG) or Venous Blood Gas (VBG)
    1. Acidosis

VI. Management

  1. ABC Management
  2. Methylene Blue 1 to 2 mg/kg IV over minutes
  3. Consider Activated Charcoal if airway is secure (e.g. cuffed Endotracheal Tube) and ingestion in last 1-2 hours

VII. References

  1. Swadron and Nordt (2022) EM:Rap 22(6): 5-7
  2. Joosen (2014) BMJ Case Rep +PMID: 24879739 [PubMed]

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