Death Associated with Nitrite Ingestion: Report of a Case

Sodium nitrite reacts with the ferrous iron of hemoglobin and oxidizes it to ferric (Fe3+) iron. This converts hemoglobin to methemoglobin, which does not react with oxygen, and thus the oxygen-carrying capacity of blood is reduced. Poisoning from accidental ingestion of sodium nitrite has been reported [1–5], and although it has been suggested that a dose of 2 mg/kg body weight will cause toxic symptons [1], recovery was reported when up to 30 mg/kg body weight (2 to 30 mg/kg body weight) was ingested and medical treatment was available within minutes. Death was reported following an accidental ingestion by a four-month-old infant of a “small amount” of 4% ethyl nitrite in liquid formula. The concentration of methemoglobin in blood from this infant was 80% of the total hemoglobin, while that of the surviving twin who had consumed less of the formula was 38% [2]. Generally, survivors have had methemoglobin levels of less than 60%, and prompt treatment with methylene blue has limited the morbidity. We present a case of suicidal sodium nitrite poisoning that caused death within 1 h and resulted in detectable concentrations of both nitrite and nitrate in certain tissues.