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Schmitt JS, Knight LD. Method Validation Study of Dipstick Urinalysis as a Screening Tool for Sodium Nitrite Toxicity. Am J Forensic Med Pathol 2024; 45:210-214. [PMID: 38754175 DOI: 10.1097/paf.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
ABSTRACT The incidence of suicide by intentional nitrite ingestion has increased since 2017. Limited options exist for commercial laboratory analysis for nitrite/nitrate. This study investigates the use of urine dipsticks for screening at autopsy for potential toxicity with sodium nitrite and, less commonly, alkyl nitrite. Archived samples of blood, urine, vitreous fluid, and gastric contents from 4 sodium nitrite/nitrate cases, 3 alkyl nitrite cases, and 4 control cases were tested using dipsticks. A rapid, strong positive result for nitrite was in the vitreous fluid of all 4-sodium nitrite/nitrate cases, along with 2 positive urine and 1 positive gastric. The 2 alkyl nitrite inhalation toxicity cases had no positive results. One alkyl nitrite ingestion case had a positive urine. The 4 controls had negative urine: equivocal results in 2 vitreous, and 1 positive gastric. Urine dipsticks are a useful adjunct to laboratory testing for nitrite toxicity and provide a rapid, cost-effective tableside result that may guide the need for further testing. Vitreous fluid and urine appear to be the most reliable specimens, although testing of gastric liquid may be useful to corroborate oral ingestion. Dipsticks may not be a reliable adjunct for testing for alkyl nitrite toxicity via inhalation route, likely due to the much lower nitrite concentration compared to nitrite ingestion cases.
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Affiliation(s)
- Jessicia S Schmitt
- From the University of Utah and ARUP Laboratories, Department of Pathology, Salt Lake City, UT
| | - Laura D Knight
- Washoe County Regional Medical Examiner's Office, and University of Nevada-Reno School of Medicine, Departments of Pathology and Pediatrics, Reno, NV
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2
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Abdelgadir EH, Al-Baladi AHK, Al-Ahmari SKSA, Alshehri SA, Kumar S. Repeated dose, 28-day oral toxicity study of curcumin, anthocyanins, and sodium nitrite in Wistar rats. Toxicon 2024; 248:108048. [PMID: 39053814 DOI: 10.1016/j.toxicon.2024.108048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE The goal of the present study was to examine the repeated dose 28-day oral toxicity of curcumin, anthocyanins, and sodium nitrite in Wistar rats. METHODS For this purpose, forty-eight male Wistar rats were randomly divided into 8 groups (n = 6 each), encompassing untreated controls and experimental groups treated with curcumin, anthocyanins, and sodium nitrite. Three rats from each group were sacrificed by cervical dislocation under di-ethyl ether anesthesia after 2 and 4 weeks of therapy, respectively. Blood samples were collected for serum chemistry. All of the animals' livers, hearts, and kidneys were removed and sent for histopathological examination. RESULTS After two weeks of inquiry, certain groups displayed higher hematological values, while others had lower values compared to the control group. AST, CK, and LDH enzyme activity were higher in groups 2-8, but urea concentrations were higher in groups 6 and 8. After four weeks, the Hb, MCH, and MCHC values in group 4 were greater, as were the WBC levels in groups 4 and 6, whereas other groups had lower MCV and WBC values. The weekly body weight gain was insignificantly different between treatment groups. Throughout the experiment, none of the animals perished. Male rats' liver, kidney, and heart underwent histopathological changes after ingesting curcumin, sodium nitrite, and anthocyanin. CONCLUSION Based on the findings, rats were more detrimental when curcumin, sodium nitrite, and anthocyanin were ingested together than when they were consumed individually, as evidenced by histopathological abnormalities in the liver, kidneys, and heart.
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Affiliation(s)
- Elkhatim H Abdelgadir
- Department of Forensic Science, College of Criminal Justice, Naif Arab University for Security Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Ayman H K Al-Baladi
- Department of Forensic Science, College of Criminal Justice, Naif Arab University for Security Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Salman K S A Al-Ahmari
- Department of Forensic Science, College of Criminal Justice, Naif Arab University for Security Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Saad A Alshehri
- Department of Forensic Science, College of Criminal Justice, Naif Arab University for Security Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Sachil Kumar
- Amity Institute of Forensic Sciences, Amity University, Noida, Uttar Pradesh, India.
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Garcia-Galindo CA, Pepin LC, Olives TD, Cole JB, Drone HM, Jones GA, Simpson NS, Fuchs RT, Robinson AE. Massive Sodium Nitrite Overdose: A Case for Prehospital Methylene Blue. PREHOSP EMERG CARE 2024:1-5. [PMID: 38781490 DOI: 10.1080/10903127.2024.2357597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
Sodium nitrite overdose leads to profound methemoglobinemia and may quickly progress to death. It is an increasingly common method of suicide and is often fatal. Methylene blue is an effective but time-sensitive antidote that has the potential to save lives when administered early. In this case report, we describe a fatal sodium nitrite overdose and the subsequent creation of a prehospital protocol for our large urban Emergency Medical Services system.
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Affiliation(s)
| | - Lesley C Pepin
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
- Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota
- Minnesota Poison Control System, Minneapolis, Minnesota
| | - Travis D Olives
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
- Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota
- Minnesota Poison Control System, Minneapolis, Minnesota
| | - Jon B Cole
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
- Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota
- Minnesota Poison Control System, Minneapolis, Minnesota
| | - Holly M Drone
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
- Hennepin EMS, Hennepin Healthcare, Minneapolis, Minnesota
| | - Gregg A Jones
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
- Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota
- Hennepin EMS, Hennepin Healthcare, Minneapolis, Minnesota
| | - Nicholas S Simpson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
- Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota
- Hennepin EMS, Hennepin Healthcare, Minneapolis, Minnesota
| | - Ryan T Fuchs
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
- Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota
- Minnesota Poison Control System, Minneapolis, Minnesota
| | - Aaron E Robinson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
- Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota
- Hennepin EMS, Hennepin Healthcare, Minneapolis, Minnesota
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Khan H, Barber C, Azrael D. Suicide by sodium nitrite poisoning: Findings from the National Violent Death Reporting System, 2018-2020. Suicide Life Threat Behav 2024; 54:310-316. [PMID: 38251179 DOI: 10.1111/sltb.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/19/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVES Suicide by sodium nitrite may be an emerging trend in the United States. Our mixed-methods study aims to: (1) describe the rates of suicides secondary to sodium nitrite self-poisoning in the United States between 2018 and 2020 and (2) characterize the use of sodium nitrite as a suicide method. METHODS Using NVDRS data, descriptive statistics, population-based incident rates/year and incidence estimates across 50 states were calculated. An inductive thematic analysis characterized the use of sodium nitrite as a suicide method on review of medical examiner and law enforcement reports. RESULTS 260 incidents were identified as suicides secondary to self-poisoning with sodium nitrite/nitrate across 37 states and 1 territory-69% of which occurred in 2020. The typical victim was a white male student with a known depressive disorder and a history of suicidal thoughts (n = 120). The annual suicide rate using sodium nitrite increased from 0.01-0.09/100,000 person-years over the three-year period. Online forums were used to share knowledge on the procurement and preparation of sodium nitrite poisoning. CONCLUSIONS Sodium nitrite self-poisoning is an increasingly used planned suicide method among young people. Further studies are required to identify the impact of means safety interventions on the incidence of sodium nitrite self-poisoning incidents.
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Affiliation(s)
- Harun Khan
- Harvard Injury Control Research Center, Boston, Massachusetts, USA
| | - Catherine Barber
- Harvard Injury Control Research Center, Boston, Massachusetts, USA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Boston, Massachusetts, USA
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Szórádová A, Hojsík D, Zdarílek M, Valent D, Nižnanský Ľ, Kovács A, Hokša R, Šidlo J. Modern suicide trend from internet. Leg Med (Tokyo) 2024; 67:102384. [PMID: 38159419 DOI: 10.1016/j.legalmed.2023.102384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The most common suicide methods vary slightly from country to country, partly related to the availability of effective means. Societal development over the years and especially the advent of the Internet has enabled the sudden spread of new suicide methods. Recently, especially since 2019, intentional sodium nitrite poisoning has appeared on many social networks as an increasingly popular method of suicide. MATERIAL AND METHODS There was performed a retrospective-prospective study of the autopsy protocols of the Medico-Legal Departments of the Healthcare Surveillance Authority in Slovakia, in a period of 15 years (2008-2022). We performed the analysis of cases of death due to nitrite poisoning, focusing on cases of intentional self-harm. In all selected cases, we present complete information, including photo documentation from the place of death, as well as the results of the performed autopsy and the results of additional laboratory examinations. RESULTS We did not record any fatal cases of unintentional, accidental consumption of sodium nitrite in Slovakia, nor any fatal cases of homicidal poisoning by this substance. However, there were three cases of intentional self-harm (completed suicide) by sodium nitrite poisoning (in 2019, 2020 and 2022). CONCLUSIONS The correct diagnosis of the cases of sodium nitrite poisoning deaths is possible only based on evaluating all the information obtained, a thorough examination of the body and the crime scene, and the correct interpretation of the findings found during a subsequent autopsy and the results of the toxicological analysis.
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Affiliation(s)
- Andrea Szórádová
- Institute of Forensic Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic; Medico-Legal Department of the Healthcare Surveillance Authority, Bratislava, Slovak Republic.
| | - Dalibor Hojsík
- Medico-Legal Department of the Healthcare Surveillance Authority, Bratislava, Slovak Republic
| | - Martin Zdarílek
- Medico-Legal and Pathological-Anatomical Department of the Healthcare Surveillance Authority, Nitra, Slovak Republic
| | - Denis Valent
- Medico-Legal Department of the Healthcare Surveillance Authority, Bratislava, Slovak Republic
| | - Ľuboš Nižnanský
- Institute of Forensic Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic; Medico-Legal Department of the Healthcare Surveillance Authority, Bratislava, Slovak Republic
| | - Alexander Kovács
- Medico-Legal Department of the Healthcare Surveillance Authority, Bratislava, Slovak Republic
| | - Richard Hokša
- Pathological-Anatomical Department of the Healthcare Surveillance Authority, Bratislava, Slovak Republic
| | - Jozef Šidlo
- Institute of Forensic Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic; Medico-Legal Department of the Healthcare Surveillance Authority, Bratislava, Slovak Republic
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Albano GD, La Spina C, Buscemi R, Palmeri M, Malandrino G, Licciardello F, Midiri M, Argo A, Zerbo S. Systematic Review of Fatal Sodium Nitrite Ingestion Cases: Toxicological and Forensic Implications. TOXICS 2024; 12:124. [PMID: 38393219 PMCID: PMC10892969 DOI: 10.3390/toxics12020124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
Documented cases of sodium nitrite toxicity are almost exclusively caused by accidental ingestion; however, self-poisoning with sodium nitrite represents an increasing trend in nitrate-related deaths. This systematic review summarizes the most crucial evidence regarding the fatal toxicity of sodium nitrite. It identifies gaps and differences in the diagnostic forensic approaches and the detection methods of sodium nitrite intoxication. A total of eleven research articles were selected for qualitative and quantitative data. Most of the studies (6/11) were case reports. Fifty-three cases of fatal intoxication with sodium nitrite were chosen for the review. More research is required to develop cost-effective techniques and uniform cutoffs for blood nitrite and nitrate levels in the event of deadly sodium nitrite poisoning. There is still a lack of critical information on other matrices and the impact of time since death on toxicological results in such situations. The available evidence provides useful recommendations for forensic pathologists and health practitioners engaged in instances of sodium nitrite poisoning or death. The data should also set off alarm bells in the public health system, in prosecutor's offices, and for policymakers so that they may undertake preventative measures to stop and restrict the unregulated market for these substances.
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Affiliation(s)
- Giuseppe Davide Albano
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Corinne La Spina
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Roberto Buscemi
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Mattia Palmeri
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Giuliana Malandrino
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Fausto Licciardello
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Mauro Midiri
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Antonina Argo
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Stefania Zerbo
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
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Smith EM. Sodium nitrite suicide and social media influence. Nursing 2023; 53:44-47. [PMID: 37973013 DOI: 10.1097/01.nurse.0000991568.99431.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
ABSTRACT This article addresses the increase in suicide rates in the US, emphasizing the emergence of sodium nitrite ingestion as a method of self-harm, particularly among adolescents and young adults influenced by social media. Given the rising incidence of sodium nitrite-related suicide attempts, healthcare providers must remain vigilant and prepared to respond effectively.
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Affiliation(s)
- Erin Murphy Smith
- Erin Murphy Smith is an associate professor at the City University of New York at Kingsborough Community College
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Un nouveau cas d’intoxication au nitrite de sodium au CHU Amiens-Picardie : un phénomène qui prend de l’ampleur ? TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2023. [DOI: 10.1016/j.toxac.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Manetti F, David MC, Gariglio S, Consalvo F, Padovano M, Scopetti M, Grande A, Santurro A. Atypical Fentanyl Transdermal Patch Consumption and Fatalities: Case Report and Literature Review. TOXICS 2022; 11:toxics11010046. [PMID: 36668772 PMCID: PMC9863810 DOI: 10.3390/toxics11010046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 06/01/2023]
Abstract
Fentanyl is a synthetic L-opioid receptor agonist, approximately 100 times more potent than morphine, that is experiencing an upward trend in the field of abuse. Fentanyl patches' abusive consumption can occur either by transdermal absorption or through other atypical and ingenious routes. In the present case, a 29-year-old man with a history of illicit drug use was found dead in a suburban neighborhood of an Italian city. At autopsy, lungs appeared increased in weight and showed minute subpleural hemorrhages. Airways contained abundant reddish foamy material; in addition, a fentanyl patch protective film was found inside the left main bronchus. Toxicological analysis revealed the presence of morphine, fentanyl, BEG and ethyl alcohol in peripheric blood; 6-MAM was also revealed in urine. Findings collected during post-mortem investigations allowed us to identify fentanyl consumption as the cause of death. Fentanyl consumption presumably took place by chewing of a transdermal patch, with subsequent aspiration of the protective film. The pathophysiology of death can be identified as combined respiratory failure-both central suppression and a fentanyl-induced increase in muscular stiffness; a further minor contribution may be identified in the mechanical airflow obstruction caused by the presence of the protective film at the bronchial level.
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Affiliation(s)
- Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Chiara David
- Ministry of the Interior, Department of Public Security, Health Central Directorate, State Police, 00185 Rome, Italy
| | - Sara Gariglio
- DIFAR—Department of Pharmacy, University of Genova, 16148 Genova, Italy
| | - Francesca Consalvo
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Martina Padovano
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Matteo Scopetti
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Antonio Grande
- Department of Public Security, Anti-Crime Central Directorate, Scientific Police Service, 00174 Rome, Italy
| | - Alessandro Santurro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
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