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Review
. 2022 Oct 27;19(21):13996.
doi: 10.3390/ijerph192113996.

Sodium Nitrite Intoxication and Death: Summarizing Evidence to Facilitate Diagnosis

Martina Padovano  1 , Mariarosaria Aromatario  2 , Stefano D'Errico  3 , Monica Concato  3 , Federico Manetti  1 , Maria Chiara David  4 , Matteo Scopetti  5 , Paola Frati  1 , Vittorio Fineschi  1
Affiliations
Review

Sodium Nitrite Intoxication and Death: Summarizing Evidence to Facilitate Diagnosis

Martina Padovano et al. Int J Environ Res Public Health. .

Abstract

Background: Over the years, forensic pathology has registered the spread of new methods of suicide, such as the ingestion of sodium nitrite. Sodium nitrite causes increased methemoglobin, resulting in systemic hypoxia, metabolic acidosis, and cyanosis. Since sodium nitrite is a preservative, the ingestion of foods containing an excessive amount of this substance can also cause acute intoxication up to death. The present review is aimed at guiding health professionals in the identification and management of sodium-nitrite-related intoxications and deaths.

Methods: A systematic literature search was carried out on PubMed by following the PRISMA statement's criteria. A total of 35 studies with 132 cases were enrolled, and the data were cataloged in Microsoft Excel. To establish the causal correlation between sodium nitrite ingestion and death, the Naranjo Adverse Drug Reaction Probability Scale was used.

Results: In addition to the small number of cases that have currently been published, the study demonstrated that there was a general methodological discrepancy in the diagnostic process. However, some interesting results have emerged, especially in post-mortem diagnostics.

Conclusion: Sodium-nitrite-related deaths represent a challenge for forensic pathologists; therefore, it is important to promptly recognize the essential features and perform the necessary and unrepeatable examinations for the correct diagnosis of the cause of death.

Keywords: autopsy findings; fatal methemoglobinemia; forensic pathology; post-mortem investigations; post-mortem toxicology; sodium nitrite; suicide.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the design of the study in accordance with the PRISMA 2020 guidelines.
Figure 2
Figure 2
Stratifications by age range; there is a subdivision between suicidal and unintentional intake of sodium nitrite, as well as the respective mortality and survival.
Figure 3
Figure 3
Absolute frequency of symptoms.
Figure 4
Figure 4
Stratification of cases in relation to intentionality and accidentality. NA: not available; M: male; F: female.
Figure 5
Figure 5
Data on the application of the Naranjo Adverse Drug Reaction Probability Scale.
Figure 6
Figure 6
Practical advice for healthcare professionals and forensic pathologists.
See this image and copyright information in PMC

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