We report a case of fatal methaemoglobinaema resulting from sodium nitrite poisoning. A 28 year old woman arrested in the emergency department following collapse. During resuscitation a venous blood gas revealed a methaemoglobin percentage of 81%. Following treatment with methylene blue, sodium bicarbonate and adrenaline, the methaemoglobin decreased. Prior to transfer to intensive care, a CT head revealed extensive hypoxic brain injury. Two days later brain death was confirmed on brainstem testing. Severe methaemoglobinaemia is rapidly fatal, with fast diagnosis and treatment associated with improved outcomes.
References
- Harvey M, Cave G, Chanwai G. Fatal methaemoglobinaemia induced by self-poisoning with sodium nitrite. Emergency Medicine Australasia 2010, vol. 22, no. 5, pp 463–465,
- Katabami K, Hayakawa M, Gando S. Severe Methemoglobinemia due to Sodium Nitrite Poisoning. Case Reports in Emergency Medicine, 2016 vol 2016 Article ID 9013816.
- Saito T, Takeichi S, Yukawa N, Osawa M. Fatal methemoglobinemia caused by liniment solution containing sodium nitrite. Journal of Forensic Sciences. 1996. Vol 41 pp 169–171
- Sodium Nitrite. Toxbase.org, National Poisons Information Service. Updated Dec 2018. Available at https://www.toxbase. org/Poisons-Index-A-Z/S- Products/Sodium-Nitrite/. Accessed 10/11/2020.
- Greenburg M, Birnkrant WB, Schiftner JJ. Outbreak of Sodium Nitrite Poisoning. American Journal of Public Health. 1945. Vol 35 pp 1217-20
- Cowled BD, Lapidge SJ, Humphrys S, Staples L. Nitrite Salts as Poisons in Baits for Omnivores. International Patent WO/2008/104028
- Dela Cruz M, Glick J, Merker SH, Vearrier D. Survival after severe methemoglobinemia secondary to sodium nitrate ingestion. Toxicology Communications 2018 Vol 2;1 pp 21-3
- Chui JSW, Poon WT, Chan KC, Chan AYW, Buckley TA. Nitrite‐induced methaemoglobinaemia – aetiology, diagnosis and treatment. Anaesthesia. 2005. Vol 60;5
- Ludlow JT, Wilkerson RG, Sahu KK, Nappe TM. Methemoglobinemia. StatPearls 2019. StatPearls Publishing, Treasure Island. PMID 30726002.
- Cawein M, Behlen CH, Lappat EJ, Cohn JE. Hereditary Diaphorase Deficiency and Methemoglobinemia. Archives of Internal Medicine. 1964 113: 578–85
Request Permissions
To request copyright permission to republish or share portions of our works, please visit Copyright Clearance Center’s (CCC) Marketplace website by clicking the button below:
