Journal
MEDICINE
Volume 101, Issue 7, Pages -Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MD.0000000000028810
Keywords
methemoglobinemia; methylene blue; sodium nitrite; suicide
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This article reports two cases of severe methemoglobinemia caused by intentional exposure to sodium nitrite. The male patient died while the female patient's symptoms resolved after treatment.
Rationale: Sodium nitrite intoxication reportedly causes severe methemoglobinemia. Recent studies reported that most clinically significant cases resulted from intentional exposure in suicidal attempts. We describe 2 cases of severe methemoglobinemia secondary to intentional sodium nitrite intoxication in suicidal attempts. Patients concerns: A 26-year-old man and 20-year-old woman attempted suicide by taking sodium nitrite, and were brought to the emergency department. Diagnosis: The male patient collapsed at the scene. He ingested approximately 18 g of sodium nitrate, and his methemoglobin level was 90.3%. The female patient was conscious, but was cyanotic. She ingested approximately 12.5 g of sodium nitrite, and her methemoglobin level was 54.6%. Interventions: The male patient received advanced cardiac life support in the emergency department. Methylene blue was immediately administered for the female patient. Outcomes: The male patient died despite aggressive resuscitation. The female patient's cyanosis resolved, and her methemoglobin level decreased to 1.2% 3 hours later. Lessons: The immediate administration of methylene blue in severe methemoglobinemia patients prevented fatal consequences. The public should be informed about the accessibility and toxicity of sodium nitrite.
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