Emergency Medicine Book


Sodium Azide Poisoning

Aka: Sodium Azide Poisoning, Sodium Azide
  1. Mechanism
    1. Sodium Azide Description
      1. Odorless white crystalline powder
    2. Sodium Azide Activity
      1. Cytochrome oxidase inhibitor
        1. Nitridizing agent
        2. Terminal oxidation inhibitor (blocks Oxidative Phosphorylation)
        3. Results in cellular asphyxia
      2. Increases cyclic guanosine monophosphate (via guanylate cyclase activation)
    3. Sodium Azide Industrial Use
      1. Antimicrobial preservative (labs)
      2. Explosive detonator
      3. Air Bag propellant (older Air Bags)
      4. Agricultural Pesticide
  2. Toxicity
    1. Very dangerous chemical in humans
    2. Lethal dose <1 grams
  3. Symptoms
    1. Dizziness
    2. Headache
    3. Nausea and Vomiting
    4. Dyspnea
  4. Signs
    1. Tachycardia
    2. Hypotension (within minutes of ingestion)
    3. Pungent, toxic odor
      1. Hydrazoic acid fumes (released on ingestion and acidification of Sodium Azide)
  5. Labs
    1. Serum Lactic Acid
      1. Increased
    2. Basic chemistry panel
      1. Metabolic Acidosis
      2. Hyperkalemia
  6. Management
    1. Staff should wear Personal Protection Equipment
    2. Patient Decontamination
      1. Remove and bag clothing
      2. Rinse patient of any remaining Sodium Azide (powder, vomit)
      3. Consider Activated Charcoal in early presentations after ingestion
    3. Aggressive supportive care
      1. Intravenous Fluids
      2. Airway management
      3. Vasopressors (Norepinephrine) for refractory Hypotension
    4. Consider Hemodialysis or plasma exchange
  7. References
    1. Tomaszewski (2019) Crit Dec Emerg Med 33(9):32

Sodium Azide (C0074721)

Definition (MSH) A cytochrome oxidase inhibitor which is a nitridizing agent and an inhibitor of terminal oxidation. (From Merck Index, 12th ed)
Concepts Hazardous or Poisonous Substance (T131) , Indicator, Reagent, or Diagnostic Aid (T130) , Inorganic Chemical (T197)
MSH D019810
SnomedCT 6261000124101
English NaN3, Azide, Sodium, Sodium Azide, NAN 003, Sodium Azide [Chemical/Ingredient], sodium azide, Sodium azide, Sodium azide (substance)
French NaN3, Azoture de sodium
Swedish Natriumazid
Czech NaN3, azid sodný
Finnish Natriumatsidi
Italian NaN3, Azoturo di sodio
Japanese アジ化ナトリウム, ナトリウムアジド, 窒化ナトリウム
German NAN 003, NaN3, Natriumazid
Spanish Azida Sódica, Acida Sódica, NaN3
Polish Azydek sodowy, NaN3
Norwegian Natriumazid, NaN3
Portuguese Azida Sódica, NaN3
Derived from the NIH UMLS (Unified Medical Language System)

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