Two cases of fatal methemoglobinemia caused by self-poisoning with sodium nitrite A case report

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.

Automated summary

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.