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

Abstract

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.