Rising trends in sodium nitrite suicides: A case series from Cape Town, South Africa
DOI:
https://doi.org/10.7196/SAMJ.2025.v115i8.3054Keywords:
Sodium nitrite, Suicide, Forensic Pathology, Forensic Toxicology, Cape Town, South Africa, Autopsy, PoisonAbstract
Sodium nitrite (NaNO2) ingestion results in methaemoglobinaemia, which can cause hypoxia, metabolic acidosis and death. Sodium nitrite is an inorganic salt, easily accessible and widely used as a colourant, food preservative and corrosion inhibitor. Although previously rarely seen in medicolegal practice, sodium nitrite poisoning cases are increasing globally. This case series examines three fatalities investigated at the Observatory Forensic Pathology Institute (formerly Salt River Mortuary) in Cape Town, Western Cape Province, South Africa, between 2020 and 2023. The three cases involve sodium nitrite, with labelled containers found at the death scene. Postmortem findings included chocolate-brown discolouration of the blood, blue-grey discolouration of the nail beds and distinctive skin lividity. Toxicological analyses included ethanol, common drugs of abuse, methaemoglobin and sodium nitrite determined in various matrices. This report highlights the importance of thorough death scene investigations and challenges in ancillary testing, and contributes to the literature on sodium nitrite-related suicides. The accessibility and rapid lethality of the chemical underscore the need for greater awareness among medical professionals and policy-makers regarding its misuse.
References
1. Tomsia M, Głaz M, Nowicka J, Szczepański M. Sodium nitrite detection in costal cartilage and vitreous humor ‒ case report of fatal poisoning with sodium nitrite. J Forensic Leg Med 2021;81:102186. https:// doi.org/10.1016/j.jflm.2021.102186
2. Padovano M, Aromatario M, D’Errico S, et al. Sodium nitrite intoxication and death: Summarizing evidence to facilitate diagnosis. Int J Environ Res Public Health 2022;19(21):13996. https://doi. org/10.3390/ijerph192113996
3. Nishiguchi M, Nushida H, Okudaira N, Nishio H. An autopsy case of fatal methemoglobinemia due to ingestion of sodium nitrite. J Forensic Res 2015;6:1-3. https://doi.org/10.4172/21577145.1000262
4. Bugelli V, Tarozzi I, Manetti AC, Stefanelli F, di Paolo M, Chericoni S. Four cases of sodium nitrite
suicidal ingestion: A new trend and a relevant forensic pathology and toxicology challenge. Leg Med
2022;59:102146. https://doi.org/10.1016/j.legalmed.2022.102146
5. Durão C, Pedrosa F, Dinis-Oliveira RJ. A fatal case by a suicide kit containing sodium nitrite ordered
on the internet. J Forensic Leg Med 2020;73:101989. https://doi.org/10.1016/j.jflm.2020.101989
6. National Department of Health, South Africa. Foodstuffs, Cosmetics, and Disinfectants Act, 1972 (Act No. 54 of 1972) as amended. Regulations relating to the labelling and advertising of foodstuffs.
Government Gazette No. 3530. 1972.
7. Freedman ML. Seven cases of poisoning by sodium nitrite. Public Health 1962;62:20-24.
8. Kaplan A, Smith C, Promnitz DA, Joffe BI, Seftel HC. Methaemoglobinaemia due to accidental sodium
nitrite poisoning. Report of 10 cases. S Afr Med J 1990;77(6):300-301.
9. Zerbo S, Spanò M, Albano GD, Buscemi R, Malta G, Argo A. A fatal suicidal sodium nitrite ingestion
determined six days after death. J Forensic Leg Med 2023;98:102576. https://doi.org/10.1016/j.
jflm.2023.102576
10. McCann SD, Tweet MS, Wahl MS. Rising incidence and high mortality in intentional sodium nitrite exposures reported to US poison centers. Clin Toxicol 2021;59(12):1264-1269. https://doi.org/10.108 0/15563650.2021.1905162
11. Smith EM. Sodium nitrite suicide and social media influence. Nursing 2023;53(12):44-47. https://doi. org/10.1097/01.NURSE.0000991568.99431.13
12. Khan H, Barber C, Azrae D. Suicide by sodium nitrite poisoning: Findings from the National Violent Death Reporting System, 2018 - 2020. Suicide Life-Threat Behav 2024;54:310-316. https://doi. org/10.1111/sltb.13043
13. Durão C, Pedrosa F, Dinis-Oliveira RJ. Another suicide by sodium nitrite and multiple drugs: An alarming trend for ‘exit’? Forensic Sci Med Pathol 2021;17:362-366. https://doi.org/10.1007/s12024- 020-00340-2
14. Yoon JC, Kim SE. Suicide attempt using sodium nitrite ordered on the internet: Two case reports. Medicine 2022;101(28):e29355. https://doi.org/10.1097/md.0000000000029355
15. Matheux A, Loiseau M, Sabini S, et al. Suicide of a young woman using a kit containing sodium nitrite ordered on the internet. Toxicol Anal Clin 2022;34(3):S139-S140. https://doi.org/10.1016/j. toxac.2022.06.232
16. Tusiewicz K, Kuropka P, Workiewicz E, Wachełko O, Szpot P, Zawadzki M. Nitrites: An old poison or a current hazard? Epidemiology of intoxications covering the last 100 years and evaluation of analytical methods. Toxics 2023;11(10):832. https://doi.org/10.3390/toxics11100832
17. Hickey TBM, MacNeil JA, Hansmeyer C, Pickup MJ. Fatal methemoglobinemia: A case series highlighting a new trend in intentional sodium nitrite or sodium nitrate ingestion as a method of suicide. Forensic Sci Int 2021;326:110907. https://doi.org/10.1016/j.forsciint.2021.110907
18. Saleh D, Lucyk S, McGillis E. Methemoglobinemia caused by sodium nitrite overdose. Can Med Ass J 2022;194(30):E1066-E1067. https://doi.org/10.1503/cmaj.220434
19. Cvetković D, Živković V, Lukić V, Nikolić S. Sodium nitrite food poisoning in one family. Forensic Sci Med Pathol 2019;15(1):102-105. https://doi.org/10.1007/s12024-018-0036-1
20. Mañibo MV, del Rosario-Fortun R. Suicide by sodium nitrite ingestion: An autopsy case report. Phillipine J Path 2024;9(2):61-64. https://doi.org/10.21141/PJP.2024.10
21. Caballero CG, Rollan VGdC, Gonzalez MAM. Suicidal poisoning by sodium nitrite: A dangerous mode from internet. In regard of a case. Spanish J Legal Med 2023;49:37-40. https://doi.org/10.1016/j. remle.2023.03.007
22. Loiseau M, Matheux A, Sabini S, et al. Suicide of an adolescent girl with sodium nitrite ordered on the internet. J Forensic Sci 2023;68(6):2200-2204. https://doi.org/10.1111/1556-4029.15350
23. Price D. Methemoglobin inducers. Goldfrank’s Toxicologic Emergencies. 8th ed. New York, NY: McGraw-Hill, 2006:1698-1706.
24. Katabami K, Hayakawa M, Gando S. Severe methemoglobinemia due to sodium nitrite poisoning. Case Rep Emerg Med 2016;9013816:1-3. https://doi.org/10.1155/2016/9013816
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